The role of nesiritide in heart failure

Background: Heart failure afflicts > 5 million patients in the US, with about 550,000 new diagnoses a year. Side effects and increased mortality limit heart failure treatment. Nesiritide is the newest addition to therapeutic options for treatment of acute decompensated heart failure (ADHF). It has been used as single in-patient infusions, multiple out-patient infusions, and perioperatively to improve hemodynamics and promote diuresis. Initially well-received, meta-analyses suggesting increased mortality and renal dysfunction after nesiritide use were published 4 – 5 years after its introduction in the US. These reports prompted new recommendations on nesiritide use by an expert panel. Objective: Critical review of the studies leading to approval of nesiritide and the current recommendations for its use. Methods: Medline search and Pubmed search using nesiritide or natrecor for text word searches. Conclusion: Nesiritide represents the first drug in a new class designed for treatment of ADHF. In patients wi...