The role of nesiritide in heart failure.
BACKGROUND
Heart failure afflicts > 5 million patients in the US, with about 550,000 new diagnoses a year. Side effects and increased mortality limit heart failure treatment. Nesiritide is the newest addition to therapeutic options for treatment of acute decompensated heart failure (ADHF). It has been used as single in-patient infusions, multiple out-patient infusions, and perioperatively to improve hemodynamics and promote diuresis. Initially well-received, meta-analyses suggesting increased mortality and renal dysfunction after nesiritide use were published 4 - 5 years after its introduction in the US. These reports prompted new recommendations on nesiritide use by an expert panel.


OBJECTIVE
Critical review of the studies leading to approval of nesiritide and the current recommendations for its use.


METHODS
Medline search and Pubmed search using nesiritide or natrecor for text word searches.


CONCLUSIONS
Nesiritide represents the first drug in a new class designed for treatment of ADHF. In patients with ADHF, nesiritide improves hemodynamic parameters and reduces dyspnea. Questions remain about possible increased mortality and side effects. A continuing study expected to enroll 7000 patients by 2010 has been designed to clarify whether nesiritide reduces mortality, hospital length-of-stay and renal parameters in patients with ADHF.
Tong
Ann T
AT
Echocardiography Laboratory, Department of Cardiology, Southwest Medical Associates, United Healthcare, Inc., 888 S Rancho Drive, Suite 209, Las Vegas, NV 89106, USA.
Rozner
Marc A
MA
D000818:Animals; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D020097:Natriuretic Peptide, Brain / Q000737:chemistry / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000379:methods
D020097:Natriuretic Peptide, Brain