Congestive heart failure is increasing in prevalence in the United States, and associated morbidity and mortality remain high. Aggressive treatment of decompensated heart failure is associated with improved outcomes; however, therapies must be tailored to the presenting characteristics of each patient and most carry a risk of adverse events stemming from the pharmaceutical itself. Nesiritide is approved for the treatment of acutely decompensated heart failure, but aggregate data analysis has suggested that it may be associated with a risk of excess mortality and worsening renal insufficiency. We review the recent evidence regarding the efficacy and safety profile of nesiritide, and discuss upcoming trials designed to address concerns regarding safety and the comparative efficacy of nesiritide.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
References and Recommended Reading
Rosamond W, Flegal K, Friday G, et al.:Heart disease and stroke statistics-2007 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.Circulation 2007,115:69–171.
Peacock WF, Emerman CL, Costanzo MR, et al.:Early initiation of intravenous vasoactive therapy improves heart failure outcomes: an analysis from the ADHERE registry database.Ann Emerg Med 2003,42:S26.
Of major importance Sackner-Bernstein JD, Kowalski M, Fox M, Aaronson K:Short-term risk of death after treatment with nesiritide for decompensated heart failure: a pooled analysis of randomized controlled trials.JAMA 2005,293:1900–1905. This pooled analysis has fueled much of the recent controversy regarding the safety profile of nesiritide.
Of major importance Sackner-Bernstein JD, Skopicki HA, Aaronson KD:Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure.Circulation 2005,111:1487–1491. This pooled analysis of the relationship between nesiritide and renal function has also fueled much of the recent controversy regarding the safety profile of nesiritide.
Hauptman PJ, Schnitzler MA, Swindle J, Burroughs TE:Use of nesiritide before and after publications suggesting drug-related risks in patients with acute decompensated heart failure.JAMA 2006,296:1877–1884.
Abraham WT, Lowes BD, Ferguson DA, et al.:Systemic hemodynamic, neurohormonal, and renal effects of a steady-state infusion of human brain natriuretic peptide in patients with hemodynamically decompensated heart failure.J Card Fail 1998,4:37–44.
Marcus LS, Hart D, Packer M, et al.:Hemodynamic and renal excretory effects of human brain natriuretic peptide infusion in patients with congestive heart failure. A doubleblind, placebo-controlled, randomized crossover trial.Circulation 1996,94:3184–3189.
Ahluwalia A, MacAllister RJ, Hobbs AJ:Vascular actions of natriuretic peptides. Cyclic GMP-dependent and-independent mechanisms.Basic Res Cardiol 2004,99:83–89.
Mills RM, LeJemtel TH, Horton DP, et al.:Sustained hemodynamic effects of an infusion of nesiritide (human b-type natriuretic peptide) in heart failure: a randomized, double-blind, placebo-controlled clinical trial. Natrecor Study Group.J Am Coll Cardiol 1999,34:155–162.
Colucci WS, Elkayam U, Horton DP, et al.:Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide Study Group.N Engl J Med 2000,343:246–253.
Publication Committee for VMAC Investigators.Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial.JAMA 2002,287:1531–1540.
Of major importance Abraham WT, Adams KF, Fonarow GC, et al.:In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE).J Am Coll Cardiol 2005,46:57–64. This large cohort analysis demonstrated inpatient survival equivalence between nitroglycerin and nesiritide, and an increased risk of death in patients requiring inotropes.
Peacock WF, Holland R, Gyarmathy R, et al.:Observation unit treatment of heart failure with nesiritide: results from the PROACTION trial.J Emerg Med 2005,29:243–252.
Burger AJ, Horton DP, LeJemtel T, et al.:Effect of nesiritide (B-type natriuretic peptide) and dobutamine on ventricular arrhythmias in the treatment of patients with acutely decompensated congestive heart failure: the PRECEDENT study.Am Heart J 2002,144:1102–1108.
Arora RR, Venkatesh PK, Molnar J:Short and long-term mortality with nesiritide.Am Heart J 2006,152:1084–1090.
Peacock WF, Emerman CL, Silver MA:Nesiritide added to standard care favorably reduces systolic blood pressure compared with standard care alone in patients with acute decompensated heart failure.Am J Emerg Med 2005,23:327–331.
Yancy CW, Saltzberg MT, Berkowitz RL, et al.:Safety and feasibility of using serial infusions of nesiritide for heart failure in an outpatient setting (from the FUSION I trial).Am J Cardiol 2004,94:595–601.
Arnold LM, Crouch MA, Carroll NV, Oinonen MJ:Out-comes associated with vasoactive therapy in patients with acute decompensated heart failure.Pharmacotherapy 2006,26:1078–1085.
Kurien S, Warfield KT, Wood CM, Miller WL:Effects of standard heart failure therapy and concomitant treatment with intravenous furosemide or inotropes (dobutamine, dopamine, and/or milrinone) on renal function and mortality in patients treated with nesiritide.Am J Cardiol 2006,98:1627–1630.
Beaver TM, Winterstein AG, Shuster JJ, et al.:Effectiveness of nesiritide on dialysis or all-cause mortality in patients undergoing cardiothoracic surgery.Clin Cardiol 2006,29:18–24.
Of importance Mentzer RM Jr, Oz MC, Sladen RN, et al.:Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: the NAPA trial.J Am Coll Cardiol 2007,49:716–726. Nesiritide use in patients undergoing cardiac surgery in the setting of pre-existing systolic dysfunction was associated with less postoperative renal impairment, as well as decreased mortality at 180 days.
About this article
Cite this article
Hiestand, B., Abraham, W.T. Safety and efficacy of nesiritide for acute decompensated heart failure: Recent literature and upcoming trials. Curr Cardiol Rep 9, 182–186 (2007). https://doi.org/10.1007/BF02938348
- Decompensated Heart Failure
- Acute Decompensated Heart Failure