Nesiritide in the initial management of acute decompensated congestive heart failure.
BACKGROUND
In the era of evolving therapy for heart failure (HF), optimal medical therapy has become challenging. Nesiritide is being used for HF therapy but its impact is still controversial.


METHODS
Prospective and randomized controlled study of 34 patients who presented to the emergency department (ED) with HF and remained symptomatic despite maximal standard therapy delivered for at least one hour. All patients had B-type natriuretic peptide BNP >100 pg/dl. Patients were randomized into Group A which received maximal standard therapy and group B which received nesiritide bolus followed by an infusion (0.01 mcg/kg/min) in addition to maximal therapy. Primary endpoints included HF hospital readmission, and hospital length of stay (LOS). Secondary endpoints included HF, cardiovascular, all-cause mortality, and adverse events. Composite risk score was designed. Results were analyzed using a logistic regression model and bootstrapping simulating approach.


RESULTS
Decrease in rehospitalizations for HF was observed during the 30 days and six-month follow-up in Group B. Earlier initiation of nesiritide therapy consistently shortened hospital LOS. Group B had a decrease in 30-day mortality but not after one year.


CONCLUSIONS
Acute HF patients who do not respond to maximal standard therapy appear to benefit from the early addition of nesiritide.
Sakr
Antoine
A
Hospital of Saint Raphael, New Haven, Department of Internal Medicine, Section of Cardiology, USA. tonysakr@hotmail.com
Hahn
Peter
P
Donohue
Thomas
T
Ghantous
Andre
A
D000368:Aged; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D016896:Treatment Outcome
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain