Emergency Departments are the last line of defense against hospital admission for CHF. Operational and liability issues that pertain to the typical Emergency Department lead to hospital admission for most CHF patients. Yet, problems with bed availability may lead to the delayed transfer of patients from the Emergency Department to the inpatient unit, further delaying important treatment. To address this, many Emergency Departments have developed extended-stay policies for the observation and continuing care of patients who cannot be discharged from the Emergency Department within a few hours of arrival. With an extended stay (< 24 hours) for evaluation and treatment in the Emergency Department, hospital admission for CHF may be significantly reduced by adequately ruling out coronary ischemia and aggressively treating the precipitating factor of the decompensation. This allows physicians to better assess the appropriateness of admission for the patient (according to Graff LG 1993 ). Initiation of a safe and effective acute therapy in addition to usual standard care may make it possible to further reduce hospital admissions or the severity of the patient's condition at the time of the admission.