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Intermittent Outpatient Nesiritide Infusion Reduces Hospital Admissions in Patients With Advanced Heart Failure

Division of Cardiology, Cedars Sinai Medical Center and University of California Los Angeles, Los Angeles, California, ernst.schwarz{at}cshs.org

Sabeen Najam, MD

Division of Cardiology, University of Texas Medical Branch, Galveston, Texas

Rami Akel, MD

Division of Cardiology, University of Texas Medical Branch, Galveston, Texas

Nasir Sulimanjee, MD

Division of Cardiology, University of Texas Medical Branch, Galveston, Texas

Susan Bionat, NP

Division of Cardiology, University of Texas Medical Branch, Galveston, Texas

Salvatore Rosanio, MD, PhD

Division of Cardiology, University of Texas Medical Branch, Galveston, Texas

Recombinant B-type natriuretic peptide (BNP) is a therapeutic modality in patients with decompensated congestive heart failure. Retrospectively tested are the effects of intermittent outpatient nesiritide infusion on symptoms, hospital readmission rates, endogenous BNP, and renal function in patients with advanced heart failure. Twenty-four patients in heart failure in New York Heart Association (NYHA) classes III-IV received a 6- to 8-hour intermittent nesiritide outpatient infusion (0.01 mcg/kg/min continuously intravenously) once weekly for a total duration of 3 months in addition to standard medical therapy. Data were analyzed retrospectively to compare hospital readmission rates, endogenous BNP levels, blood urea nitrogen, and creatinine levels 1 year before and up to 12 months after starting treatment. All patients tolerated nesiritide infusions well with no significant adverse events. At the end of the observation period, NYHA classes had improved 1 class in 16 patients and 2 classes in 4 patients and remained unchanged in 4 patients. There was a significant reduction in hospital readmissions within 1 year with nesiritide treatment compared with the year before (0.94 ± 0.8 vs 3.6 ± 2.2, P < .005). No significant changes were seen regarding endogenous BNP levels (1002 ± 870 vs 1092 ± 978 pg/mL, P = .95), blood urea nitrogen levels (45 ± 28 vs 45 ± 26 mg/dL, P = .96), and a tendency of slightly elevated creatinine levels that did not differ significantly compared with prior levels (1.76 ± 0.85 vs 1.1 ± 0.56 mg/dL, P = .5). Intermittent outpatient nesiritide treatment resulted in improved symptoms and reduced hospital readmission rates without a significant decline in renal function in patients with advanced heart failure but did not alter endogenous BNP levels.

Key Words: nesiritide • heart failure • renal function

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