Nesiritide utilization evaluation in a university teaching hospital.
OBJECTIVE
Nesiritide is a new vasodilator approved for decompensated heart failure (DHF). Compared with nitroglycerin, nesiritide improves haemodynamics and symptoms in the first 3 h of therapy. However, nesiritide is more expensive than nitroglycerin (US$380-1500 daily vs. US$2-5 daily). Since its approval in the US in late 2001, nesiritide use has increased dramatically in our institution. Nesiritide has become a focus of our multidisciplinary drug utilization initiative, aimed at performing a nesiritide utilization evaluation (NUE) and developing a nesiritide usage guideline.


METHODS
Medical records of patients who received nesiritide from 1 October 2003 to 31 March 2004 were reviewed. Nesiritide utilization pattern was presented to the initiative group for guideline development.


RESULTS
A total of 162 records were reviewed. A 22.6% of inappropriate usage was reported. The most significant inappropriate usage was in patients who received the agent for precardiac valvular surgery optimization, followed by those for diuresis in non-cardiac-related fluid overload states. The median duration of nesiritide therapy was 6 days (range 1-94). The median length of stay (LOS) in our institution was 14 days (National statistics DHF LOS: 5.3 days). Eliminating inappropriate nesiritide usage can lead to a potential of US$141 886 savings per year.


CONCLUSIONS
Based on the results, a 48-h nesiritide restriction policy was implemented. Usage beyond 48 h requires Heart Failure Service approval. Future NUE will evaluate the effectiveness of this policy. The overall management of DHF also needs to be evaluated to improve efficiency of care.
Cheng
J W M
JW
Long Island University, Brooklyn, NY, USA. judy.cheng@liu.edu
Merl
M Y
MY
Nguyen
H M
HM
Caliendo
G C
GC
Meyers
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003627:Data Interpretation, Statistical; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D017408:Guidelines as Topic; D006333:Heart Failure / Q000188:drug therapy* / Q000191:economics; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000191:economics / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000191:economics / Q000627:therapeutic use*
D002317:Cardiovascular Agents; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain