Intermittent Outpatient Infusion of Nesiritide in Patients With Decompensated Congestive Heart Failure
Jeffrey B. Sack*; Jayme A. Sack, MD and Michael B. Kesselbrenner, MD
Sarasota Memorial Hospital Centre for CV Disease, Sarasota, FL
PURPOSE: Congestive heart failure is a leading cause of morbidity and mortality in western cultures. Nesiritide has been used for the treatment of acute decompensation in a hospital setting. There has been conflicting data regarding its use in the outpatient setting.
METHODS: We prospectively evaluated the use of IV nesiritide in an outpatient heart failure clinic. Patients with severe LV dysfunction who remained symptomatic despite standard treatment received an initial bolus of 2 ucg/kg followed by a continuous infusion of .01 ucg/kg/min for 3 hours, 3 times per week for 10 weeks. Clinical, hemodynamic, and echocardiographic parameters were obtained on all patients before and after treatment. Patients were asked to fill out the Kansas City Heart Failure questionnaire and followed a minimum of 12 months post treatment.
RESULTS: There were 83 patients (54 m, 29 f) with a mean age of 79.9 years. Ischemic cardiomyopathy was the leading cause of CHF (86.7%). The mean ejection fraction was 27.4%. The mean KCHF score was 38.1. The median NYHA classification at the start of treatment was 3. The mean number of hospitalizations in the 12 months prior to treatment was 3. There were no hospitalizations for decompensation in any patient during the treatment period and 12 months post treatment (p < .0001). No patient died during the study period. There was significant improvement in ejection fraction (27.4 vs. 34.6, p < 0.0001), functional NYHA class (3 vs. 2, p < .0001) and KCHF score (38.1 vs 56.8, p < 0.0001). No significant change in renal function as measured by serum creatinine and creatinine clearance was seen (1.2 vs 1.2, p = NS, 58.0 vs 61.2, p = NS, respectively).
CONCLUSION: The addition of intermittent intravenous nesiritide led to significant improvement in symptoms and LV function and significantly lowered the number of hospitalizations. In our study, Nesiritide was not associated with worsening renal function.
CLINICAL IMPLICATIONS: Nesiritide can be beneficial to patients with HF in the outpatient setting.
DISCLOSURE: Jeffrey Sack, No Financial Disclosure Information; No Product/Research Disclosure Information
doi:10.1378/chest.9331
(Chest. 2010; 138:848A)
© 2010 American College of Chest Physicians
Dr. Jeffrey Sack 