Nonglycosidic adrenergic and nonadrenergic inotropic drugs improve systemic hemodynamics and left ventricular function in patients with severe congestive heart failure. As these beneficial effects are observed with short-term therapy, the use of these agents should be restricted to the treatment of acute heart failure. Long-term therapy with adrenergic agents as well as the phosphodiesterase inhibitors appears to enhance mortality in patients with chronic systolic heart failure. Potential indications for long-term therapy with nonglycosidic inotropic drugs include vesnarinone and ibopamine for selected patients with refractory heart failure or as pharmacologic bridges to cardiac transplantation.