Information on the probable efficacy and safety of drugs for individualized patients should change both the economics and the management of congestive heart failure. Rapidly profiling patients should enhance the ability to develop "designer" drugs for those with similar disease phenotypes. Pharmacogenomics also may resurrect promising drugs that did not show benefit when previously added to standard therapy. The promise of pharmacogenomics has to be tempered, however, by a sensitivity to concerns regarding the potential misuse of genomic information, including loss of confidentiality for the patient, as well as possible stigmatization of groups. Such difficult genoethical issues must be addressed in order to reap the full benefits of this evolving and exciting field.