Intravenous Nesiritide vs Nitroglycerin for Treatment of Decompensated Congestive Heart Failure A Randomized Controlled Trial

HEART FAILURE OCCURS IN 4.7 million persons living in the United States, and is the discharge diagnosis in approximately 3.5 million hospitalizations annually. Hospitalizations account for 60% of health care expenditures for heart failure. Despite its enormous human and economic burden, no new intravenous agents for acutely decompensated congestive heart fa i lure (CHF) have been approved for use in the United States in more than a decade. Furthermore, the rapid relief of symptoms without significant complications or adverse effects of drug therapy have not been addressed previously in patients hospitalized with heart failure. There is increasing recognition that agents with positive inotropic activity can increase mortality despite acute hemodynamic improvement. Current guidelines from the American College of Cardiology and the American Heart Association for management of acutely decompensated CHF and decompensation of chronic CHF without cardiogenic shock advocate use of inotropic agents (dobutamine and dopamine) only if administration of morphine, loop diuretics, sublingual and intravenous nitroglycerin, and nitroprusside provide insufficient improvement. Yet, intravenous inotropic agents continue to be used commonly for this syndrome. Nesiritide is a recombinant human brain, or B-type, natriuretic peptide that is identical to the endogenous hormone produced by the ventricle in response to increased wall stress, hypertrophy, and volume overload. Nesiritide has venous, arterial, and coronary vasodilatory properties that reduce preload and afterload, increase cardiac out-