Nesiritide provides no additional benefit in the emergency department

General

Clinical Question:
In patients presenting to an emergency department with acutely decompensated heart failure, does the addition of nesiritide to standard treatment decrease return visits or hospitalization?

Bottom Line:
Nesiritide (Natrecor), when added to standard therapy for heart failure in the emergency department, does not reduce return visits or hospitalizations over the subsequent 30 days as compared with standard therapy alone. (LOE = 1b)

Reference:
Miller AH, Nazeer S, Pepe P, Estes B, Gorman A, Yancy CW. Acutely decompensated heart failure in a county emergency department: a double-blind randomized controlled comparison of nesiritide versus placebo treatment. Ann Emerg Med 2008; 51(5):571-578.  [PMID:18304693]

Study Design:
Randomized controlled trial (double-blinded)

Allocation:
Concealed

Setting:
Emergency department

Synopsis:
Nesiritide is a B-type natriuretic peptide that decreases afterload through vasodilation and natriuresis. The researchers conducting this study enrolled 101 patients using concealed allocation. All patients had heart failure ranging from New York Heart Association class II -- dyspnea on exertion -- to class IV heart failure -- dyspnea at rest or with minimal exertion. More than half of the patients were men. All patients were treated with a standard protocol of oxygen as needed, diuretic, and the patient's previous therapy. Patients also received normal saline placebo or nesiritide 2 mcg/kg bolus followed by 0.01 mcg/kg per minute for up to 8 hours. Re-admission to the emergency department or hospital over the next 30 days was similar in both groups, occurring in 41.5% of patients receiving nesiritide and 39.6% of patients receiving placebo (P = NS).

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