Chronic heart failure is a progressive syndrome which continues to have high rates of morbidity and mortality. Heart failure rates are increasing in parallel with the ageing population, as are rates of hospitalisation for acute episodes of decompensated failure. Little progress has been made in the medical management of such episodes. Positive inotropes, including selective phosphodiesterase III inhibitors, are associated with increased mortality when administered over the long term. Now newer approaches, using selective agents such as enoximone orally at lower doses alone or in combination with carefully titrated beta1-selective adrenergic blockade, may provide a more favourable outcome in terms of symptom management, functional status and improved survival. Trials are underway to determine whether this is the case. Published trials with enoximone and protocols for forthcoming trials are reviewed.