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Critical review and recommendations for nesiritide use in the emergency department

Sean P Collins1, William R Hinckley, Alan B Storrow

  • 1Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio 45267-0769, USA.

The Journal of Emergency Medicine
|September 27, 2005
PubMed

Insights

Acute decompensated heart failure treatment in the emergency department (ED) has not changed significantly. Intravenous nesiritide shows potential as a new therapy for heart failure patients in the ED.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Pharmacology

Background:

  • Heart failure is a growing epidemic, affecting millions and increasing in incidence and prevalence.
  • Current emergency department (ED) treatments for acute decompensated heart failure (ADHF) have seen little advancement since the 1970s.
  • Existing ADHF therapies include diuretics, vasodilators, and inotropes, with rising healthcare costs associated with the condition.

Purpose of the Study:

  • To evaluate the potential of intravenous nesiritide as a therapeutic option for emergency department management of acute decompensated heart failure.
  • To discuss recent clinical trial outcomes for nesiritide in hospitalized heart failure patients.
  • To provide recommendations for the appropriate use of nesiritide in the ED setting.

Main Methods:

  • Review of recent high-profile clinical trials evaluating intravenous nesiritide (human B-type natriuretic peptide).
  • Analysis of trial results in the context of the emergency department patient population.
  • Formulation of recommendations for ED use based on existing evidence.

Main Results:

  • Recent trials suggest potential benefits of intravenous nesiritide in select hospitalized heart failure patients.
  • Nesiritide may offer a therapeutic addition or alternative to current ED treatments for ADHF.
  • Further investigation is warranted to establish nesiritide's role in emergency heart failure care.

Conclusions:

  • Intravenous nesiritide presents a promising therapeutic avenue for acute decompensated heart failure in the emergency department.
  • Evidence from recent trials supports considering nesiritide for specific ADHF patient cohorts.
  • Recommendations are provided for the judicious application of nesiritide in emergency heart failure management.

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