title: Acutely decompensated heart failure in a county emergency department: a double-blind randomized controlled comparison of nesiritide versus placebo treatment.
abstract: OBJECTIVE
  Acutely decompensated congestive heart failure is a major cause of emergency department (ED) visits in county hospitals. This often underserved population has a high rate of return visits to the ED for heart failure. Nesiritide has been demonstrated to relieve symptoms of acutely decompensated congestive heart failure. We examined the effect of an 8-hour infusion of nesiritide on the composite of return to the ED or hospitalization at 30 days.
  
  
  METHODS
  A prospective, randomized, double-blinded, placebo-controlled trial of nesiritide plus protocol-specified standard therapy versus standard therapy done in the ED for acutely decompensated congestive heart failure.
  
  
  RESULTS
  One hundred one patients were randomized during a 16-month enrollment period. Sixty-six percent of the patients were men and 34% were women. Fifty-six percent were black; all patients had New York Heart Association class II to IV heart failure and most had dyspnea at rest or with minimal exertion. Complete follow-up data were available in 97 of 101 patients. After the 8-hour treatment period, acute symptom relief was experienced in 95.7% of the nesiritide group (95% confidence interval [CI] 88.9% to 100%) versus 86.8% of the placebo group (95% CI 72% to 98.9%), with an absolute difference between the 2 groups of 8.9% (95% CI -3.3% to 24.2%). Diuresis was similar between the 2 groups, but hypotension occurred more frequently in the nesiritide-treated group. The primary outcome measure of return visit to the ED or hospitalization at 30 days was higher for nesiritide (41.5%) than placebo (39.6%; absolute difference 1.9%; 95% CI -17.2% to 21.1%). There was only 1 death. No measurable change in renal function was observed.
  
  
  CONCLUSIONS
  Administration of nesiritide for acutely decompensated congestive heart failure in a county ED was no better than standard therapy alone for return to the ED or hospitalization at 30 days.
authors.affiliation: Department of Surgery/Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8579, USA. Adam.Miller@UTSouthwestern.edu
authors.forename: Adam H
authors.initials: AH
authors.lastname: Miller
authors.forename: Shameem
authors.initials: S
authors.lastname: Nazeer
authors.forename: Paul
authors.initials: P
authors.lastname: Pepe
authors.forename: Barbi
authors.initials: B
authors.lastname: Estes
authors.forename: April
authors.initials: A
authors.lastname: Gorman
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D012008:Recurrence
chemical_list: D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain