Short and long-term mortality with nesiritide

  • Arora R
  • Venkatesh P
  • Molnar J
 et al. 
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Background: Nesiritide (recombinant human B-type natriuretic peptide) has been shown to provide symptomatic and hemodynamic improvement in acute decompensated heart failure. A previous meta-analysis of 3 randomized controlled trials has suggested an increased short-term risk of death with nesiritide use. We performed a meta-analysis of 7 available randomized controlled trials to evaluate the short- and long-term risk of death with nesiritide use for acute decompensated heart failure. Methods: Seven large randomized controlled nonmortality trials on nesiritide with available data on 30-day mortality were included. Data on 180-day mortality were available only in 4 trials. Mortality data in nesiritide and control arms were extracted from the selected trials and the nesiritide database (Scios Inc, Fremont, CA). Results: The pooled estimate of the relative risks (RRs) for unadjusted 30- and 180-day mortality revealed no significant differences between the nesiritide arm (RR 1.243, 95% CI 0.798-1.935) and control arm (RR, 0.002, 95% CI 0.798-1.259), respectively). Conclusions: Unlike a previous analysis, our meta-analysis indicates that nesiritide is not associated with a higher 30- or 180-day mortality. Further analysis of mortality adjusted for confounding variables such as nesiritide dose, duration of infusion, concurrent use of inotropes, heart failure stage, and arrhythmias may reveal subgroups in jeopardy. Large-scale randomized controlled trials powered to evaluate mortality are required to conclusively address these findings. © 2006 Mosby, Inc. All rights reserved.

Author-supplied keywords

  • Holter monitoring
  • Sr-vasc
  • Swan Ganz catheter
  • acute decompensated heart failure/dt [Drug Therapy
  • acute decompensated heart failure/et [Etiology]
  • acute decompensated heart failure/su [Surgery]
  • acute heart failure
  • acute heart failure/dt [Drug Therapy]
  • acute heart failure/et [Etiology]
  • acute heart failure/su [Surgery]
  • angiotensin receptor antagonist
  • angiotensin receptor antagonist/dt [Drug Therapy]
  • article
  • beta adrenergic receptor blocking agent
  • beta adrenergic receptor blocking agent/dt [Drug T
  • cardiomyopathy
  • clinical trial
  • comparative study
  • confidence interval
  • continuous infusion
  • data analysis
  • data base
  • dipeptidyl carboxypeptidase inhibitor
  • dipeptidyl carboxypeptidase inhibitor/dt [Drug The
  • dobutamine
  • dobutamine/cm [Drug Comparison]
  • dobutamine/ct [Clinical Trial]
  • dobutamine/dt [Drug Therapy]
  • drug efficacy
  • drug fatality
  • drug fatality/si [Side Effect]
  • drug safety
  • glyceryl trinitrate
  • glyceryl trinitrate/cm [Drug Comparison]
  • glyceryl trinitrate/ct [Clinical Trial]
  • glyceryl trinitrate/dt [Drug Therapy]
  • heart arrhythmia
  • heart arrhythmia/si [Side Effect]
  • heart hemodynamics
  • heart index
  • heart left ventricle ejection fraction
  • human
  • hypotension
  • hypotension/si [Side Effect]
  • inotropic agent
  • inotropic agent/cm [Drug Comparison]
  • inotropic agent/ct [Clinical Trial]
  • inotropic agent/dt [Drug Therapy]
  • kidney failure
  • kidney failure/si [Side Effect]
  • low drug dose
  • lung capillary pressure
  • meta analysis
  • mortality
  • nesiritide
  • nesiritide/ae [Adverse Drug Reaction]
  • nesiritide/cm [Drug Comparison]
  • nesiritide/ct [Clinical Trial]
  • nesiritide/do [Drug Dose]
  • nesiritide/dt [Drug Therapy]
  • nesiritide/iv [Intravenous Drug Administration]
  • placebo
  • priority journal
  • spironolactone
  • spironolactone/dt [Drug Therapy]
  • statistical analysis
  • statistical significance
  • systematic review
  • systolic blood pressure
  • treatment duration
  • treatment outcome
  • vasodilator agent
  • vasodilator agent/cm [Drug Comparison]
  • vasodilator agent/ct [Clinical Trial]
  • vasodilator agent/dt [Drug Therapy]

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  • Rr Arora

  • Pk Venkatesh

  • J Molnar

  • Arora R.R.

  • Venkatesh P.K.

  • Molnar J.

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