OBJECTIVES: To assess the formulary status of currently used drugs, therapeutic guidelines and perceptions about the appropriateness of treatment of ADHF in community hospitals. METHODS: A Web-based survey of pharmacy directors at community hospitals that were part of a national group purchasing organization. RESULTS: One-hundred seven hospitals participated in the survey (response rate 47.1%). Diuretics like furosemide and bumetanide were more commonly included (100% and 94.4%, respectively) in hospital formularies than torsemide (69.2%). Dopamine and dobutamine were more common (94.4% each) on the formulary than milrinone (68.2%). Nitroprusside and nitroglycerin were listed on the formulary of more than 90% of institutions, while nesiritide was listed on the formulary in only 48.6% of hospitals and placed on “restricted” status in 36.4% of hospitals. Guidelines for care of patients with ADHF were used in the emergency department (ED), inpatient care units, and outpatient clinics in 18.6%, 43.0% and 8.5% of hospitals respectively. Overall, ADHF care including general treatment as well as specific use of nesiritide was deemed to be appropriate in the majority of patients but nearly twice as many respondents perceived the management of ADHF and specific use of nesiritide was inappropriate in ED compared to the inpatient treatment. Only 41.1% of the respondents reported following Braunwald recommendations for the use of nesiritide. CONCLUSION: A sizable percentage of responding community hospitals did not have guidelines for treatment of ADHF despite existence of such in the literature. There are potential opportunities for improvement in the general treatment of ADHF as well as use of nesiritide in ADHF especially in the ED or observation unit versus inpatient.