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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The therapeutic goals for patients hospitalized with acute decompensated heart failure are to reverse acute hemodynamic abnormalities, relieve symptoms, and provide the ability to initiate early treatment, which will decrease disease progression and improve long-term survival. The use of nesiritide on top of standard care, such as diuretic therapy, has been proven to lead to meaningful clinical benefits in a broad range of acutely decompensated heart failure patients. Nesiritide is an attractive therapeutic option because of its more rapid and sustained hemodynamic profile with less adverse effects than alternative heart failure treatments, such as nitroglycerine or dobutamine. The use of nesiritide represents an entirely new treatment approach to reverse acutely decompensated heart failure and to facilitate optimization of the heart failure medical regimen.
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PMID:Nesiritide: practical guide to its safe and effective use. 1243 60

Nesiritide, the commercially available form of B-type natriuretic hormone, improved the overall clinical status of patients with acutely decompensated congestive heart failure and several indicators of cardiovascular function in randomized trials. In a trial comparing it to a variety of other agents, efficacy was similar, but fewer patients receiving nesiritide required intravenous diuretics. Nesiritide was associated with significantly lower 6-month mortality than dobutamine, which was found to be more proarrhythmic in an open-label trial. Nesiritide also caused a faster and greater improvement in pulmonary capillary wedge pressure than intravenous nitroglycerin. Adverse effects for nesiritide are generally lower than for other vasoactive agents used for heart failure. The primary adverse effect, hypotension, is dose related and causes symptoms in only about 4% of patients at the current recommended dose. Other side effects are minor or occur infrequently.
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PMID:Safety and efficacy of nesiritide for the treatment of decompensated heart failure. 1243 28

Heart failure is characterized by sodium and fluid retention, sympathetic overactivity, parasympathetic withdrawal, vasoconstrictor activation and cytokine elevation. New therapies for heart failure attempt to control neurohormonal activation and limit progressive left ventricular dysfunction. Nesiritide (human B-type natriuretic peptide) is a recently approved new vasodilator that has been given to almost 1,000 patients in numerous clinical investigations; it belongs to a new class of heart failure drugs known as natriuretic peptides. Nesiritide decreases pulmonary capillary wedge pressure, systemic vascular resistance, mean right atrial pressure and pulmonary artery pressure, while improving cardiac index, stroke volume and heart failure symptoms. Many endothelin receptor antagonists are in various stages of development. Early clinical studies have demonstrated beneficial cardiovascular hemodynamic effects. Other new drugs for heart failure also include calcium sensitizers, neutral endopeptidase and vasopeptidase inhibitors, aldosterone receptor antagonists, vasopressin antagonists and cytokine inhibitors. All are being actively investigated and many show significant promise as beneficial therapies in the treatment of heart failure.
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PMID:New therapies for the treatment of congestive heart failure. 1253 83

Human BNP serves to compensate for deteriorating cardiac function causing preload and afterload reductions, natriuresis, diuresis, suppression of the renin-angiotensin-aldosterone system (RAAS) and endothelin-1, and lowering of norepinephrine. Based on its unique pharmacologic profile, nesiritide results in clinically significant balanced vasodilation of arteries and veins, and may be well suited for patients presenting with various scenarios of decompensated CHF usually due to volume overload (NYHA classes II-IV). More than 1000 subjects have participated in clinical trials with nesiritide and more than 55,000 patients have been treated with nesiritide since it was approved for use in August 2001. Unlike nitroglycerin, tachyphylaxis did not appear to occur with Natrecor. 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 increasing heart rate. Unlike inotropes, the beneficial hemodynamic effects produced by nesiritide do not cause an increase in myocardial oxygen consumption (MVO(2)), an important consideration for patients with acutely decompensated heart failure. Because Nesiritide is not an inotrope, it does not affect myocardial contractility, as does a beta-adrenergic receptor agonist, or a phosphodiesterase III inhibitor. As a result, nesiritide is not arrhythmogenic. Nesiritide should be considered for patients presenting with acutely typical or useful decompensated heart failure, especially those with dyspnea at rest or with minimal activity.
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PMID:Nesiritide: a new therapy for the treatment of heart failure. 1266 89

The standard treatment for acute heart failure (synonymous with pulmonary edema) is an upright posture, oxygen, morphine (often accompanied by an antiemetic), and intravenous diuretics. This treatment has remained unchanged for many years, and the precise mechanism by which each of these methods alleviates symptoms in patients is unclear. Nitrates, oral or intravenous, are also used with benefit, and have some hemodynamic advantages over intravenous diuretics. Recently, three new forms of treatment have been investigated. The use of milrinone, a phosphodiesterase inhibitor, for exacerbation of heart failure in patients with a background of chronic heart failure was not advantageous. The trials of levosimendan, a calcium sensitizer, in patients with pulmonary edema hinted at benefit. Nesiritide, a formulation of brain natriuretic peptide, does bring about hemodynamic improvement in acute heart failure, and is at least as effective as nitroglycerin, easier to prescribe, but prone to cause hypotension. These are small but important advances that increase our knowledge of the pathophysiology of acute heart failure, and also provide an indication of which drugs are preferable for the treatment of this distressing condition.
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PMID:New therapies for the management of acute heart failure. 1269 42

Patients with end-stage heart failure awaiting heart transplant are often maintained on continuous intravenous inotropic therapy. However, this therapy alone is often inadequate for maintenance of appropriate pulmonary artery pressure and stable clinical course. Nesiritide, B-type natriuretic peptide, is a recently released intravenous vasodilator for short-term use in patients with decompensated heart failure. This report details experience in four patients in whom this agent was used to bridge to transplant for prolonged periods (11-35 days) with added clinical benefit and without obvious tolerance. This suggests that new strategies for pretransplant management may be needed.
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PMID:Sustained use of nesiritide to aid in bridging to heart transplant. 1276 47

Hospital admissions for acute decompensated heart failure (ADHF) have increased precipitously during the past few decades and are projected to continue to increase in the future. To optimize patient outcomes and reduce the costs associated with this disorder, evidenced-based pharmacotherapy is essential. Continuous infusions of loop diuretic therapy rather than bolus dosing may enhance efficacy and reduce the extent of diuretic resistance. Nesiritide is a pharmacologically novel preload and afterload reducer but based on clinical trial evidence should be reserved for those unable to take or with resistance to intravenous nitrate therapy. Catecholamine- and phosphodiesterase-based inotropic therapies are efficacious, but the increased risk of arrhythmogenesis and the potential for negative survival effects limit their use. The experimental agent levosimendan is a positive inotropic agent but does not increase myocyte calcium concentrations as do catecholamines or phosphodiesterase inhibitors. Clinical trial evidence demonstrates a positive survival benefit for levosimendan versus dobutamine.
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PMID:Acute decompensated heart failure: a contemporary approach to pharmacotherapeutic management. 1292 Dec 47

The benefits of nesiritide for the treatment of acute decompensated heart failure (ADHF) are discussed. In order to understand the goals of ADHF therapy, it is important to recognize the complex interplay between hemodynamic and neurohormonal abnormalities in patients suffering from heart failure. Goals of therapy include improvement in hemodynamic parameters, relief of symptoms, and minimization of adverse effects. Until recently, therapy with diuretics, positive inotropes, and intravenous vasodilators was the standard of care for treating ADHF. Nesiritide is the newest agent available for treating ADHF and may offer several benefits over standard of care therapy. It is important to remember that therapy for ADHF should not replace chronic oral heart failure therapy, nor should focus on prevention of ADHF episodes be lost.
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PMID:Treatment options for acute decompensated heart failure. 1296 1

The use of nesiritide in the improvement of patient hemodynamics, decreased length of stay (LOS), and rehospitalization is discussed. Nesiritide is a useful agent for the treatment of the acutely decompensated heart failure patient. Previous trials suggest that the use of nesiritide results in improved outcomes as compared with other agents. To date, there are no data comparing nesiritide to milrinone in the treatment of the acutely decompensated heart failure patient. Fifty-five patients admitted to the heart failure service were identified retrospectively; 29 received nesiritide and 26 received milrinone. Baseline characteristics, hemodynamic data, and LOS data were collected. Primary outcomes were the overall LOS, intensive care LOS, and readmission within 30 days of discharge. Other outcomes included duration of vasoactive agents used, overall diuresis, and total cost of therapy. Baseline hemodynamic data were similar between groups. Patients in the milrinone group had an overall LOS of 8.2 days compared to 7 days in the nesiritide group (p = NS). LOS in the intensive care unit was 5.9 days in the milrinone group compared with 3.9 days in the nesiritide group (p = 0.007). Readmission at 30 days was 28% in the milrinone group compared with 16% in the nesiritide group (p = NS). Infusion time was shorter in the nesiritide group, 50 versus 117 hours (p = 0.001). Cost of therapy (cost of bed, supplies, and drug) was $398 less per patient receiving nesiritide. The use of nesiritide led to improvement in patient hemodynamics and resulted in a trend toward decreases in LOS and rehospitalization. Total cost of therapy was lower in the nesiritide group as compared to those patients treated with milrinone.
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PMID:Effect of nesiritide versus milrinone in the treatment of acute decompensated heart failure. 1296 2

The therapeutic goals for patients hospitalized with acutely decompensated heart failure are to reverse acute hemodynamic abnormalities, relieve symptoms, and to initiate heart failure therapies which will decrease disease progression and improve long-term survival. Nesiritide (recombinant B-type natriuretic peptide) is the first in a new class of therapeutic agents for the treatment of heart failure and has been demonstrated to offer a unique combination of safety and efficacy. The use of nesiritide on top of standard care including diuretic therapy, has been proven to lead to meaningful clinical benefits in a broad range of acutely decompensated heart failure patients. Nesiritide is an attractive therapeutic option because of its more rapid and sustained hemodynamic profile, more favorable effects on neurohormonal suppression, with less adverse effects than alternative intravenous heart failure treatments such as nitroglycerine, nitroprusside, dobutamine, or milrinone. The use of nesiritide is the most effective initial treatment approach among currently available strategies to reverse acutely decompensated heart failure and to facilitate optimization of the heart failure medical regimen.
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PMID:B-type natriuretic peptide: spectrum of application. Nesiritide (recombinant BNP) for heart failure. 1457 51


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