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Positive inotropic agents are primarily used to improve cardiac output and tissue perfusion. This is because they enhance the contractility of the heart muscle, meaning that the heart is able to pump more forcefully with each beat. As a result, there is an increase in the volume of blood ejected from the ventricles during systole, which directly impacts the overall cardiac output. Improved cardiac output is essential, especially in patients with heart failure or other conditions where the heart's pumping efficiency is compromised.

By enhancing tissue perfusion, these agents help to ensure that organs and tissues receive an adequate blood supply, which is critical for maintaining cellular function and overall health.

The other options do not accurately reflect the primary purpose of positive inotropic agents. While some medications might have secondary effects on heart rate or vascular tone, the hallmark of positive inotropic therapy is its ability to significantly boost the heart's output and improve blood flow to the tissues.