Comparison of ultrafiltration, nesiritide, and usual care in acute decompensated heart failure

To study the short-term effects of initial treatment strategies for acute decompensated heart failure, 25 patients treated with ultrafiltration (UF) were retrospectively compared with 25 patients treated with usual care (UC) and 25 patients treated with UC plus adjunctive nesiritide infusion (UN), matched for age, sex, ejection fraction, etiology, and serum creatinine. The median length of hospitalization was 6 days for UF, 4 days for UC, and 6 days for UN. All-cause 30-day readmissions tended to be fewer in the UF (16%) compared with the UN (24%) or UC (24%) groups. All groups lost weight, although to a greater extent in the UF group (15.8 lb vs 6.3 lb in UC and 4.7 lb in UN). Concomitantly, UF manifested the greatest increase in serum urea nitrogen, creatinine, and the number of patients with creatinine increases of >0.5 mg/dL (44% vs 24% in UC and 20% in UN). In acute decompensated heart failure, UF appears to be more effective for volume removal and possibly prevention of all-cause hospital readmission to 30 days than UC or UN. These findings, as well as the effects on renal function and length of stay, need to be further evaluated in a prospective randomized study.