Nesiritide (Natrecor) for Acute Decompensated Heart Failure

Initial data from moderately sized controlled trials and large prospective registries suggested that nesiritide is safe.3-5 However, nesiritide has been associated with a transient and significant increase in serum creatinine.1-4 In a pooled analysis,3 nesiritide was associated with an increase in mortality within 30 days of treatment, although the difference was of borderline statistical significance (7.2 versus 4.0 percent; P = .059). Nesiritide improves short-term hemodynamics in hospitalized patients with acute decompensated heart failure who have not benefited from aggressive treatment with standard care.1,2,5 However, nesiritide may cause renal function to worsen and may increase the risk of death within 30 days.3 Patients should be notified about the potential risks of treatment; nesiritide is not indicated for serial treatments in the outpatient setting.