CLINICAL STUDY: HEART FAILURE
Effect of nesiritide versus dobutamine on short-term outcomes in the treatment of patients with acutely decompensated heart failure
Marc A. Silver, MD*,*,
Darlene P. Horton, MD ,
Jalal K. Ghali, MD and
Uri Elkayam, MD
* Heart Failure Institute, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
Scios Inc., Sunnyvale, California, USA
Cardiac Centers of Louisiana, Shreveport, Louisiana, USA
Los Angeles County-University of Southern California Medical Center, Los Angeles, California, USA
Manuscript received August 10, 2001;
revised manuscript received November 21, 2001,
accepted December 11, 2001.
* Reprint requests and correspondence: Dr. Marc A. Silver, Director, Heart Failure Institute, Advocate Christ Medical Center, 4440 West 95th Street, Suite 428 South, Oak Lawn, Illinois 60453, USA.
marc.silver{at}advocatehealth.com
OBJECTIVES: This study was designed to determine whether nesiritide, administered for acute decompensated congestive heart failure (CHF), affects healthcare costs by hospital length of stay (LOS), readmissions and short-term mortality, compared to dobutamine.
BACKGROUND: Dobutamine is a commonly used inotropic treatment for CHF. Although dobutamine may have favorable hemodynamic and symptomatic effects, its use may be associated with side effects such as tachycardia, cardiac arrhythmias and myocardial ischemia. Nesiritide (B-type natriuretic peptide) is a new intravenous (IV) drug that produces hemodynamic and symptomatic improvement through balanced vasodilatory effects, neurohormonal suppression and enhanced natriuresis and diuresis.
METHODS: From an open-label randomized study of nesiritide versus standard care (SC) in patients with CHF requiring hospitalization, we compared short-term outcome data from patients given nesiritide (0.015 or 0.03 µg/kg per min) with a subgroup of SC patients given dobutamine. A total of 261 patients are included in this analysis.
RESULTS: Compared to dobutamine, both nesiritide doses were administered for a shorter total duration (p < 0.001), and the total duration of all IV vasoactive therapy (including study drug) was also shorter (p  0.012). Although there was no difference in LOS, there was a trend toward decreased readmissions in the two nesiritide groups (8% and 11%, respectively, vs. 20% in the dobutamine group). Six-month mortality was lower in the nesiritide groups.
CONCLUSIONS: Treatment of decompensated CHF with nesiritide may lead to lower healthcare costs and reduced mortality compared to treatment with dobutamine.
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Abbreviations and Acronyms
| | NYHA | | BP | | blood pressure | | CHF | | congestive heart failure | | IV | | intravenous | | LOS | | length of stay | | MI | | myocardial infarction | | NYHA | | New York Heart Association | | SC | | standard care | | VT | | ventricular tachycardia |
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