title: Dobutamine Therapy is Associated with Worse Clinical Outcomes Compared with Nesiritide Therapy for Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Inotropes and natriuretic peptides are essential components of current therapeutic options for acute decompensated heart failure (ADHF). This systematic review examines the therapeutic effectiveness of dobutamine and brain natriuretic peptide, nesiritide, in reducing mortality and readmission rates for ADHF treatment.
  
  
  METHODS
  Published studies related to dobutamine and nesiritide therapy in ADHF were identified via an exhaustive search of scientific literature databases. The identified studies, published between 2002 and 2012, were carefully screened based on our predefined inclusion criteria. Selected studies were pooled, and odds ratios (ORs) and 95% confidence intervals (95% CI) for each outcome were calculated. Subgroup analysis was conducted to assess the influence of ethnicity on the study outcome.
  
  
  RESULTS
  Seven cohort studies were selected for this meta-analysis. These seven studies included 959 ADHF patients who underwent nesiritide treatment and 1748 ADHF patients who received dobutamine therapy. Our meta-analysis revealed a significantly lower survival rate in dobutamine-treated patients compared with nesiritide-treated patients (OR 0.48, 95% CI 0.36-0.63, P < 0.001). Additionally, a markedly higher readmission rate was associated with dobutamine treatment compared with nesiritide treatment (OR 0.52, 95% CI 0.36-0.73, P < 0.001). A stratified analysis based on ethnicity revealed a significantly lower survival in dobutamine-treated ADHF patients in Caucasian and mixed populations compared with nesiritide treatment (Caucasian: OR 0.60, 95% CI 0.38-0.94, P = 0.024; Mixed: OR 0.38, 95% CI 0.26-0.56, P < 0.001). However, a similar association was not detected in Asian populations (P = 0.738). Further, dobutamine-treated ADHF patients displayed higher readmission rates than did nesiritide-treated patients in both Caucasian and mixed-race populations (all P < 0.05).
  
  
  CONCLUSIONS
  Our study suggests that dobutamine therapy is associated with poorer outcomes, with higher in-hospital mortality rates and increased readmission rates compared with nesiritide therapy in ADHF patients. Thus, current treatment strategies need to be redesigned for better outcomes.
authors.affiliation: Department of Thoracic and Cardiac Surgery, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.|Department of Thoracic and Cardiac Surgery, The Affiliated Jiangyin Hospital of Southest University Medical College, Jiangyin, People's Republic of China.
authors.forename: Xiao-Chen
authors.initials: XC
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Nursing College of Nanjing Medical University, Nanjing, People's Republic of China.|Department of Cardiology, The Affiliated Jiangyin Hospital of Southest University Medical College, Jiangyin, Jiangyin, People's Republic of China.
authors.forename: Dong-Min
authors.initials: DM
authors.lastname: Zhu
authors.affiliation: Department of Cardiology, Linfen People's Hospital, No. 17, Liberation Road, Linfen, 041000, People's Republic of China. yuxuans24@126.com.
authors.forename: Yu-Xuan
authors.initials: YX
authors.lastname: Shan
mesh_terms: D000208:Acute Disease; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D004280:Dobutamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010359:Patient Readmission; D016019:Survival Analysis
chemical_list: D002316:Cardiotonic Agents; D020097:Natriuretic Peptide, Brain; D004280:Dobutamine