Nesiritide not effective for acute heart failure

January 01, 0001

Nesiritide not effective for acute heart failure

Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent. These US investigators randomly assigned 7141 patients who were hospitalized with acute heart failure to receive either nesiritide or placebo for 24 to 168 hours in addition to standard care. Coprimary end points were the change in dyspnea at 6 and 24 hours, as measured on a 7-point Likert scale, and the composite end point of rehospitalization for heart failure or death within 30 days.

They found: "Patients randomly assigned to nesiritide, as compared with those assigned to placebo, more frequently reported markedly or moderately improved dyspnea at 6 hours (44.5% vs. 42.1%) and 24 hours (68.2% vs. 66.1%), but the prespecified level for significance was not met. The rate of rehospitalization for heart failure or death from any cause within 30 days was 9.4% in the nesiritide group versus 10.1% in the placebo group (NS). There were no significant differences in rates of death from any cause at 30 days (3.6% with nesiritide vs. 4.0% with placebo) or rates of worsening renal function, defined by more than a 25% decrease in the estimated glomerular filtration rate (31.4% vs. 29.5% (NS)."

The authors concluded: "Nesiritide was not associated with an increase or a decrease in the rate of death and rehospitalization and had a small, nonsignificant effect on dyspnea when used in combination with other therapies. It was not associated with a worsening of renal function, but it was associated with an increase in rates of hypotension. On the basis of these results, nesiritide cannot be recommended for routine use in the broad population of patients with acute heart failure."

Overall not a useful treatment.

For the full abstract, click here.

N Engl J Med 365:32-43, 7 July 2011 © 2011 to the Massachusetts Medical Society
Effect of Nesiritide in Patients with Acute Decompensated Heart Failure. C.M. O'Connor, R.C. Starling, A.F. Hernandez, et al. Correspondence to Dr. O’Connor: [email protected]

Category: K. Circulatory. Keywords: nesiritide, acute heart failure, dyspnea, reshospitalization, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 26 July 2011

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