Outcomes of patients hospitalized for acute decompensated heart failure: does nesiritide make a difference?
BACKGROUND
Nesiritide is indicated in the treatment of acute decompensated heart failure. However, a recent meta-analysis reported that nesiritide may be associated with an increased risk of death. Our goal was to evaluate the impact of nesiritide treatment on four outcomes among adults hospitalized for congestive heart failure (CHF) during a three-year period.


METHODS
CHF patients discharged between 1/1/2002 and 12/31/2004 from the Adventist Health System, a national, not-for-profit hospital system, were identified. 25,330 records were included in this retrospective study. Nesiritide odds ratios (OR) were adjusted for various factors including nine medications and/or an APR-DRG severity score.


RESULTS
Initially, treatment with nesiritide was found to be associated with a 59% higher odds of hospital mortality (Unadjusted OR = 1.59, 95% confidence interval [CI]: 1.31-1.93). Adjusting for race, low economic status, APR-DRG severity of illness score, and the receipt of nine medications yielded a nonsignificant nesiritide OR of 1.07 for hospital death (95% CI: 0.85-1.35). Nesiritide was positively associated with the odds of prolonged length of stay (all adjusted ORs = 1.66) and elevated pharmacy cost (all adjusted ORs > 5).


CONCLUSIONS
In this observational study, nesiritide therapy was associated with increased length of stay and pharmacy cost, but not hospital mortality. Randomized trials are urgently needed to better define the efficacy, if any, of nesiritide in the treatment of decompensated heart failure.
Carroll
Richard J
RJ
1Adventist Health System, LaGrange, Illinois, USA. richard.carroll@ahss.org
Mulla
Zuber D
ZD
Hauck
Loran D
LD
Westbrook
Audrey
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016527:Drug Costs; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000191:economics / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000191:economics / Q000627:therapeutic use*; D016017:Odds Ratio; D012189:Retrospective Studies; D016896:Treatment Outcome
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain