Nesiritide (Natrecor)

Approved for acute, decompensated congestive heart failure.

A recombinant B-type natriuretic peptide (BNP)with vasodilatory properties.

Not proven to be better than standard treatments.

30-day mortality in decompensated congestive heart failure 7.1% compared to 4.8% in placebo patients.

In decompensated congestive heart failure deterioration of renal function is three times more common than the use of placebo.

Acute CHF patients with renal impairment treated with low dose dopamine or low dose nesiritide did not improve congestion or renal function (The ROSE Acute Heart Failure Randomized Trial).

Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) trial evaluated the effect of this drug, in addition to standard care, on rates of dyspnea at 6 and 24 hours, rehospitalization for heart failure or death from any cause at 30 days, and renal dysfunction-not associated with an increase or a decrease in the rate of death and rehospitalization, had a nonsignificant effect on dyspnea, not associated with worsening renal function, had increased rates of hypotension, and not recommended for acute heart failure(O’Connor CM et al).

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