Effect of nesiritide versus dobutamine on short-term outcomes in the treatment of patients with acutely decompensated heart failure.
OBJECTIVE
This study was designed to determine whether nesiritide, administered for acute decompensated congestive heart failure (CHF), affects healthcare costs by hospital length of stay (LOS), readmissions and short-term mortality, compared to dobutamine.


BACKGROUND
Dobutamine is a commonly used inotropic treatment for CHF. Although dobutamine may have favorable hemodynamic and symptomatic effects, its use may be associated with side effects such as tachycardia, cardiac arrhythmias and myocardial ischemia. Nesiritide (B-type natriuretic peptide) is a new intravenous (IV) drug that produces hemodynamic and symptomatic improvement through balanced vasodilatory effects, neurohormonal suppression and enhanced natriuresis and diuresis.


METHODS
From an open-label randomized study of nesiritide versus standard care (SC) in patients with CHF requiring hospitalization, we compared short-term outcome data from patients given nesiritide (0.015 or 0.03 microg/kg per min) with a subgroup of SC patients given dobutamine. A total of 261 patients are included in this analysis.


RESULTS
Compared to dobutamine, both nesiritide doses were administered for a shorter total duration (p < 0.001), and the total duration of all IV vasoactive therapy (including study drug) was also shorter (p less-than-or-equal 0.012). Although there was no difference in LOS, there was a trend toward decreased readmissions in the two nesiritide groups (8% and 11%, respectively, vs. 20% in the dobutamine group). Six-month mortality was lower in the nesiritide groups.


CONCLUSIONS
Treatment of decompensated CHF with nesiritide may lead to lower healthcare costs and reduced mortality compared to treatment with dobutamine.
Silver
Marc A
MA
Heart Failure Institute, Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA. marc.silver@advocatehealth.com
Horton
Darlene P
DP
Ghali
Jalal K
JK
Elkayam
Uri
U
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000191:economics* / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000191:economics* / Q000627:therapeutic use*; D004280:Dobutamine / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D010359:Patient Readmission / Q000191:economics; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D020097:Natriuretic Peptide, Brain; D004280:Dobutamine; D009320:Atrial Natriuretic Factor