title: Intermittent outpatient nesiritide infusion reduces hospital admissions in patients with advanced heart failure.
abstract: Recombinant B-type natriuretic peptide (BNP) is a therapeutic modality in patients with decompensated congestive heart failure. Retrospectively tested are the effects of intermittent outpatient nesiritide infusion on symptoms, hospital readmission rates, endogenous BNP, and renal function in patients with advanced heart failure. Twenty-four patients in heart failure in New York Heart Association (NYHA) classes III-IV received a 6- to 8-hour intermittent nesiritide outpatient infusion (0.01 mcg/kg/min continuously intravenously) once weekly for a total duration of 3 months in addition to standard medical therapy. Data were analyzed retrospectively to compare hospital readmission rates, endogenous BNP levels, blood urea nitrogen, and creatinine levels 1 year before and up to 12 months after starting treatment. All patients tolerated nesiritide infusions well with no significant adverse events. At the end of the observation period, NYHA classes had improved 1 class in 16 patients and 2 classes in 4 patients and remained unchanged in 4 patients. There was a significant reduction in hospital readmissions within 1 year with nesiritide treatment compared with the year before (0.94 +/- 0.8 vs 3.6 +/- 2.2, P < .005). No significant changes were seen regarding endogenous BNP levels (1002 +/- 870 vs 1092 +/- 978 pg/mL, P = .95), blood urea nitrogen levels (45 +/- 28 vs 45 +/- 26 mg/dL, P = .96), and a tendency of slightly elevated creatinine levels that did not differ significantly compared with prior levels (1.76 +/- 0.85 vs 1.1 +/- 0.56 mg/dL, P = .5). Intermittent outpatient nesiritide treatment resulted in improved symptoms and reduced hospital readmission rates without a significant decline in renal function in patients with advanced heart failure but did not alter endogenous BNP levels.
authors: Division of Cardiology, Cedars Sinai Medical Center and University of California Los Angeles, Los Angeles, California 90048, USA. ernst.schwarz@cshs.org
authors: Ernst R
authors: ER
authors: Schwarz
authors: Sabeen
authors: S
authors: Najam
authors: Rami
authors: R
authors: Akel
authors: Nasir
authors: N
authors: Sulimanjee
authors: Susan
authors: S
authors: Bionat
authors: Salvatore
authors: S
authors: Rosanio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D010359:Patient Readmission; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D045283:Natriuretic Agents; D011994:Recombinant Proteins; D020097:Natriuretic Peptide, Brain; D003404:Creatinine