The use of outpatient IV nesiritide was considered a promising treatment option for symptomatic chronic decompensated HF patients that merits further investigation. Such an approach, once validated, should be integrated into an evidence-based HF disease management program. In heart failure (HF) has become a major health problem.
Full Answer
Can Nesiritide be used to treat heart failure?
“Natrecor (nesiritide) is indicated for the intravenous treatment of patients with acutely decompensated congestive heart failure who have dyspnea at rest or with minimal activity. In this population, the use of Natrecor reduced pulmonary capillary wedge …
What is the rate of rehospitalization for heart failure from Nesiritide?
I think that it is an injustice to the ever growing population of the chronic decompensated heart failure patient to be denied treatment of Nesiritide in the outpatient setting. Patients can, and have been safely and effectively managed, and monitored in an outpatient setting under the direction of heart failure specialists.
Does decompensated heart failure require intravenous vasoactive drugs?
Nesiritide thus cannot be recommended in the broad population of patients with acute decompensated heart failure represented by the study population in this trial.
What is intravenous Nesiritide used for?
Background: Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent. Methods: We randomly assigned 7141 patients who were hospitalized with acute heart failure to receive either nesiritide or placebo for 24 to 168 hours …
Why is nesiritide used in heart failure?
Nesiritide, a recombinant human B-type natriuretic peptide, is the first in a new drug class for the treatment of decompensated heart failure. The drug binds to receptors in the vasculature, kidney, adrenal gland, and brain, and overcomes resistance to endogenous BNP present in patients with CHF.
Is nesiritide used for heart failure?
Nesiritide (Natrecor) is a recombinant form of human B-type (brain) natriuretic peptide that has beneficial vasodilatory, natriuretic, diuretic and neurohormonal effects. The drug is administered intravenously for the management of patients with decompensated congestive heart failure (CHF).
What type of heart failure does nesiritide treat?
“Natrecor (nesiritide) is indicated for the intravenous treatment of patients with acutely decompensated congestive heart failure who have dyspnea at rest or with minimal activity.
What is the treatment for decompensated heart failure?
Common in-hospital treatments include intravenous diuretics, vasodilators, and inotropic agents. Novel pharmaceutical agents have shown promise in the treatment of acute decompensated heart failure and may simplify the treatment and reduce the morbidity associated with the disease.
How is nesiritide administered?
NATRECOR (nesiritide) is for intravenous (IV) use only. There is limited experience with administering NATRECOR for longer than 96 hours. Monitor blood pressure closely during NATRECOR administration.
What is the nesiritide IV infusion used for in this case?
Natrecor (nesiritide) is indicated for the intravenous treatment of patients with acutely decompensated congestive heart failure who have dyspnea at rest or with minimal activity. In this population, the use of Natrecor reduced pulmonary capillary wedge pressure and improved dyspnea.
How does nesiritide increase cardiac output?
Vasodilation occurs without a change in heart rate and is associated with increases in stroke volume and cardiac output. Nesiritide may promote diuresis because of a direct natriuretic action, increased cardiac output, and/or decreased aldosterone levels.
What class of drug is nesiritide?
Nesiritide Overview Nesiritide is a prescription medication used to treat patients with severe heart failure who have trouble breathing. Nesiritide belongs to a group of drugs called vasodilators.Mar 24, 2017
Does Natrecor increase heart rate?
The complete efficacy profile of nesiritide included preload reduction (PCWP and RAP), reductions in pulmonary artery pressures, afterload reduction (systemic vascular resistance), and increases in cardiac index and stroke volume index (which are dose-dependent and not the result of a direct inotropic effect), without ...
What is the most important treatment for a patient suffering from CHF exacerbation?
The main goal in treatment for CHF exacerbation is to reduce the fluid volume in the body. If recently prescribed beta-blockers or other medication changes caused your CHF exacerbation, you may be given diuretics, which are water pills that increase the amount of water and salt that leave your body through urination.Jun 23, 2021
What happens when a patient decompensated?
Decompensated and compensated HF In medicine, the term decompensation refers to the deterioration of a structure or system that was previously functioning. This means the heart can no longer continue to compensate for its defects. A system that is compensated can function despite the presence of stressors or defects.
Which medication reduces the workload of the heart by treating abnormal heart rhythms?
Beta-blockers treat high blood pressure, heart failure, abnormal heart rhythms (arrhythmia) and chest pain (angina). They may help prevent future heart attacks.
Is heart failure a major health problem?
Acute decompensated heart failure is a major health problem that is associated with several million hospitalizations worldwide each year, poor short-term outcomes, and high costs. 1-3 Despite the magnitude of the problem, rates of early death and rehospitalization have not improved over the past several decades. 3.
Is Nesiritide approved for heart failure?
Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent.
Is Nesiritide approved for heart failure?
Background: Nesiritide is approved in the United States for early relief of dyspnea in patients with acute heart failure. Previous meta-analyses have raised questions regarding renal toxicity and the mortality associated with this agent.
Does nesiritide increase or decrease the rate of death?
Conclusions: Nesiritide was not associated with an increase or a decrease in the rate of death and rehospitalization and had a small, nonsignificant effect on dyspnea when used in combination with other therapies.
What is nesiritide used for?
The infusion of nesiritide in patients admitted to the hospital for treatment of decompensated congestive heart failure resulted in improvements in hemodynamic function and rapid and sustained improvements in clinical status. Two aspects of this study represent a departure from the usual way that vasoactive agents for congestive heart failure are evaluated. First, the effect of therapy on the chief symptoms of decompensated congestive heart failure was measured prospectively. Second, the study population comprised patients admitted specifically for management of decompensated congestive heart failure.
How long does the efficacy trial last?
In the efficacy trial, the treatment assignment was revealed after the assessment at six hours. In the comparative trial, the global clinical status and symptoms were also evaluated at 24 hours and at the end of therapy (lasting up to 7 days).
How long does dobutamine treatment last?
Among the 102 patients assigned to standard therapy, dobutamine was the most common choice of medication (in 57 percent of patients), followed by milrinone (19 percent), nitroglycerin (18 percent), dopamine (6 percent), and amrinone (1 percent). A Swan–Ganz catheter was used in 19 percent of the patients receiving standard therapy and 18 percent of the patients receiving either dose of nesiritide.
Is nesiritide a B type peptide?
Intravenous infusion of nesiritide, a brain (B-type) natriuretic peptide, has beneficial hemodynamic effects in patients with decompensated congestive heart failure. We investigated the clinical use of nesiritide in such patients.
Is nesiritide good for congestive heart failure?
Intravenous nesiritide is useful for the short-term treatment of decompensated congestive heart failure. Symptomatic decompensation is the most common reason for the hospitalization of patients with congestive heart failure due to left ventricular systolic dysfunction.
What is the target oxygen saturation for COPD?
However, patients who also have chronic obstructive pulmonary disease (COPD) may not require aggressive oxygen therapy, since the target O 2 saturation in such patients is 88 to 92 percent. In patients with both acute heart failure and COPD, we aim for the upper end of that range.
How long can you take Nitroprusside?
Thus, the use of nitroprusside is limited to selected patients, usually for durations of less than 24 to 48 hours. Use of nitroprusside in patients with ADHF is based largely upon expert opinion since available published evidence is very limited [ 14 ].
What is vasodilator therapy?
A vasodilator that decreases arterial tone (eg, nitroprusside) is recommended for patients with urgent need for afterload reduction (eg, severe hypertension). A vasodilator therapy that primarily decreases venous tone (eg, nitroglycerin) may be used as an adjunct to diuretic therapy for patients without an adequate response to diuretics. Vasodilator therapy is a component of therapy for patients with refractory HF and low cardiac output , as discussed below and separately. (See "Management of refractory heart failure with reduced ejection fraction", section on 'Approaches to specific refractory heart failure presentations' .)
Can inotropes increase atrial arrhythmias?
In addition, inotropic agents can increase atrial [ 32] and ventricular [ 34] arrhythmias. Given these concerns, careful patient selection is required for inotrope use. (See "Use of vasopressors and inotropes" and "Inotropic agents in heart failure with reduced ejection fraction", section on 'Intravenous therapy' .)
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Is sodium restriction recommended for HF?
Sodium restriction — Sodium restriction has been commonly recommended in patients with acute or chronic HF, although there are insufficient data to support any specific level of sodium intake in patients with symptomatic HF, as noted in the 2013 ACC/AHA and 2012 European Society of Cardiology (ESC) guidelines [ 5,19 ]. Given the available evidence, we suggest sodium restriction (eg, <2 g/d) in patients with symptomatic HF. The 2013 ACC/AHA guidelines suggest some degree (eg, <3 g/d) of sodium restriction in patients with symptomatic HF [ 19 ], while the 2012 ESC guidelines note that the safety and efficacy of salt restriction require further study [ 19 ]. (See "Patient education: Low-sodium diet (Beyond the Basics)" .)
Is morphine sulfate used in ADHF?
Morphine therapy is not mentioned in the 2010 Heart Failure Society of America guidelines on management of ADHF or in the 2013 ACC/AHA guidelines. The role of morphine sulfate in patients with ADHF who have an acute myocardial infarction is discussed separately.
Abstract
It remains unclear if early administration of i.v. nesiritide in patients hospitalized with acute heart failure (AHF ) is associated with improved clinical outcomes.
Introduction
Acute heart failure (AHF) is a major cause of hospital admission globally and is associated with high morbidity and mortality. 1 - 3 Dyspnoea is a primary symptom among patients hospitalized with AHF. Early i.v. loop diuretics and vasodilators are the primary therapies to relieve congestion in AHF. 2, 4, 5
Methods
The methodology, protocol, and primary results of ASCEND‐HF have been published previously. 7, 8 In brief, ASCEND‐HF was a randomized, double‐blinded, placebo‐controlled trial of nesiritide in addition to standard care among adult patients hospitalized with HF.
Results
Of the 7430 randomized study subjects, 7430 patients received study medications according to the protocol.
Discussion
This analysis had several findings that are relevant to the interpretation and study design of contemporary AHF trials: (i) time to study medication administration varied significantly across world regions; (ii) ED randomization and hospital admission timing were associated with earlier study drug administration; and (iii) earlier administration of study medication after hospital presentation was independently associated with modestly better early dyspnoea improvement but not early post‐discharge outcomes..
Citing Literature
Marco Metra, John R. Teerlink, Gad Cotter, Beth A. Davison, G. Michael Felker, Gerasimos Filippatos, Barry H. Greenberg, Peter S. Pang, Piotr Ponikowski, Adriaan A. Voors, Kirkwood F. Adams, Stefan D. Anker, Alexandra Arias-Mendoza, Patricio Avendaño, Fernando Bacal, Michael Böhm, Guillermo Bortman, John G.F. Cleland, Alain Cohen-Solal, Maria G.
When was nesiritide reviewed?
In 2005, an expert panel reviewed nesiritide at the request of the U.S. Food and Drug Administration in response to reports of worsened renal function and mortality. The expert panel stated that the use of nesiritide should be strictly limited to treatment of patients with acutely decompensated heart failure who have dyspnea at rest.
Why are inotropes used in heart failure?
Rationale: Positive inotropes are used to increase the force of myocardial contraction in the treatment of a patient with heart failure. Negative inotropes would cause the heart to have a decreased force of myocardial contraction and would not be effective.
What is the difference between nesiritide and lisinopril?
nesiritide (Natrecor) Rationale: Nesiritide is used in the intensive care setting as a final effort to treat severe, life-threatening heart failure, often in combination with several other cardiostimulatory medications. Lisinopril (Prinivil) is an ACE inhibitor that is used in the management of heart failure.
What are some examples of ACE inhibitors?
Diuresis results, which decreases preload, or the left ventricular end-volume, and the work of the heart. Examples: lisinopril, enalapril, fosinopril, quinapril, captopril, ramipril, trandolapril, and perindopril.
How does diuresis affect the heart?
This causes diuresis, which decreases blood volume and blood return to the heart. This in turn decreases preload, or the left ventricular end-diastolic volume, and the work required of the heart. The patient is discharged home and returns to the emergency department 4 days later.
Does carvedilol slow heart rate?
Carvedilol (Coreg) has been shown to slow the progression of heart failure and to decrease the frequency of hospitalization in patients with mild to moderate (class II or III) heart failure. Atropine is used to increase heart rate.
Can digoxin cause bradycardia?
The apical pulse is slightly under 60, but bradycardia may occur with digoxin therapy and the heart rate should be monitored. The ankle edema may be a manifestation of his heart failure and not a new concern.