Critical review and recommendations for nesiritide use in the emergency department.
Heart failure is a disease of epidemic proportions. Almost five million Americans suffer from heart failure and over 400,000 patients are newly diagnosed with heart failure each year. Indeed, heart failure is now the only cardiovascular disease that is increasing in incidence and prevalence. Costs related to heart failure are $18.8 billion per year and are steadily increasing. Although the outpatient management of these patients has seen substantial improvement in the last two decades, emergency department (ED) treatment of acute decompensated heart failure has remained largely unchanged since the late 1970s. Current ED therapy consists of diuretics, intravenous vasodilatators, and inotropes. Recently, the outcomes of several high-profile clinical trials evaluating intravenous nesiritide (human B-type natriuretic peptide) have suggested a benefit in select hospitalized patients. Such a therapy has potential to provide a therapeutic addition or alternative for emergency heart failure management. We discuss these trials' results, suggest their relationship to the ED population, and provide recommendations for appropriate ED use.
Collins
Sean P
SP
Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio 45267-0769, USA.
Hinckley
William R
WR
Storrow
Alan B
AB
D002316:Cardiotonic Agents / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D045283:Natriuretic Agents / Q000191:economics / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000191:economics / Q000627:therapeutic use*; D005996:Nitroglycerin / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use; D018879:Ventricular Premature Complexes / Q000188:drug therapy
D002316:Cardiotonic Agents; D045283:Natriuretic Agents; D014665:Vasodilator Agents; D020097:Natriuretic Peptide, Brain; D005996:Nitroglycerin