In the Usual Group, therapy was tailored to the following goals: a) absence of evidence of elevated intracardiac filling pressures; relief of orthopnea; relief of abdominal discomfort attributed to hepatosplenchnic congestion; resolution of peripheral edema, ascites, and rales; reduction of jugular venous distension to 5 cm or less above sternal angle; and b) adequate peripheral perfusion; warm extremities, if they could be achieved, and pulse pressure 25 percent or more , or, if less, the greatest which could be achieved. Either during or after hemodynamic monitoring, therapy could be adjusted to achieve the clinical goals above and further adjusted, if necessary to maintain adequate blood pressure and renal function for all patients. Patients for whom therapy was adjusted without hemodynamic monitoring could crossover for hemodynamic monitoring at any time they reached certain criteria. The criteria for crossover included: need to add intravenous inotropic agents above 3 mcg/kg/minute to prevent symptomatic hypotension; repeated inability to discontinue low-dose inotropic agents; or renal insufficiency.