Annals of Emergency Medicine
Volume 51, Issue 5 , Pages 571-578 , May 2008

Acutely Decompensated Heart Failure in a County Emergency Department: A Double-Blind Randomized Controlled Comparison of Nesiritide Versus Placebo Treatment

  • Adam H. Miller, MD, MSc

      Affiliations

    • Department of Surgery/Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
    • Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX
    • Corresponding Author InformationAddress for reprints: Adam H. Miller, MD, MSc, Department of Surgery, Division of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8579; 214-648-2965, fax 214-648-8243
    • ,
  • Shameem Nazeer, MD

      Affiliations

    • Department of Surgery/Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Paul Pepe, MD, MPH

      Affiliations

    • Department of Surgery/Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Barbi Estes, RN

      Affiliations

    • Department of Surgery/Division of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • April Gorman, MS

      Affiliations

    • Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Clyde W. Yancy, MD

      Affiliations

    • Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX.

References 

  1. Dargie HJ, McMurray JJ, McDonagh TA. Heart failure: implications of the true size of the problem. J Intern Med. 1996;239:309–315
  2. American Heart Association. Heart disease and stroke statistics: 2007 update. www.americanheart.orgAccessed 2007
  3. Rich MW. Management of heart failure in the elderly. Heart Fail Rev. 2002;7:89–97
  4. Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics: 2006 update: a report from the AHA Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;14:e85–e151
  5. Fonorrow G, Adams KF, Abraham WT, et al. ADHERE Scientific Advisory Committee, Study Group, and Investigators Risk for in-hospital mortality in acute decompensated heart failure: classification and regression tree analysis. Jama. 2005;293:572–580
  6. Rame JE, Sheffield MA, Dries DL, et al. Outcomes after emergency department discharge. Am Heart J. 2001;142:714–719
  7. Mills RM, Lejemtel TH, Horton DP, et al. Sustained hemodynamic effects of an infusion of nesiritide (human b-type natriuretic peptide) in heart failure: a randomized, double-blind, placebo controlled clinical trial. J Am Coll Cardiol. 1999;34:155–162
  8. Colucci WS, Elkayam U, Horton DP, et al. Nesiritide Study Group Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. N Engl J Med. 2000;343:246–253
  9. Publication Committee for the VMAC Investigators. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. jama. 2002;287:1531–1540
  10. Peacock WF, Emmerman CL PROACTION Study group. Safety and efficacy of nesiritide in the treatment of decompensated heart failure in observation patients. J Am Coll Cardiol. 2003;41(suppl A):336A
  11. Peacock WF, Emmerman CL, Silver MA. Nesiritide added to standard care favorably reduces systolic blood pressure compared with standard care alone in patients with acute decompensated heart failure. Am J Emerg Med. 2005;23:327–331
  12. Gheorghiade M, Abraham WT, Albert NM. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. Jama. 2006;296:2217–2226

 Supervising editor: Judd E. Hollander, MD

 Author contributions: AHM and SN obtained institutional review board approval. AHM, SN, and BE collected data. AHM, BE, AP, and CY analyzed data. AHM and AP conducted the statistical analysis. AHM, PP, and CWY developed the article. AHM takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. This project was supported by grant number KL2RR024983 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research, and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCRR or NIH. This study was an investigator-initiated protocol, independently designed, initiated, supervised and analyzed by the investigators but funded by an unrestricted research grant from Scios, Inc. CWY is a consultant for GlaxoSmithKline, Scios, Inc., NitroMred, Medtronic, AstraZeneca, Otsuka and has received grants and research support from GlaxoSmithKline, Scios Inc., NitroMed, and Medtronic. CWY has also received CHF Fellowship salary support from Medtronic and Scios, Inc. CWY is on the speaker's bureau for GlaxoSmithKline and Novartis. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online March 4, 2008.

PII: S0196-0644(07)01852-5

doi: 10.1016/j.annemergmed.2007.12.003

Annals of Emergency Medicine
Volume 51, Issue 5 , Pages 571-578 , May 2008

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