Outcomes of patients hospitalized for acute decompensated heart failure: does nesiritide make a difference?

CHF patients discharged between 1/1/2002 and 12/31/2004 from the Adventist Health System, a national, not-for-profit hospital system, were identified. 25,330 records were included in this retrospective study. Nesiritide odds ratios (OR) were adjusted for various factors including nine medications and/or an APR-DRG severity score.Initially, treatment with nesiritide was found to be associated with a 59% higher odds of hospital mortality (Unadjusted OR = 1.59, 95% confidence interval [CI]: 1.31–1.93). Adjusting for race, low economic status, APR-DRG severity of illness score, and the receipt of nine medications yielded a nonsignificant nesiritide OR of 1.07 for hospital death (95% CI: 0.85–1.35). Nesiritide was positively associated with the odds of prolonged length of stay (all adjusted ORs = 1.66) and elevated pharmacy cost (all adjusted ORs > 5).In this observational study, nesiritide therapy was associated with increased length of stay and pharmacy cost, but not hospital mortality. Randomized trials are urgently needed to better define the efficacy, if any, of nesiritide in the treatment of decompensated heart failure.Congestive heart failure (CHF) is a significant public health concern and pressing public policy issue. With greater than 5 million patients who carry the diagnosis of CHF in the United States alone, and with approximately 550,000 new cases per year, it is no surprise that acute decompensated heart failure (ADHF) is the leading cause of hospitalization in the U.S. in persons over the age of 65 years [1,2]. Hospital discharges for CHF rose from 377,000 in 1979 to 970,000 in 2002, an increase of 157%. In 2005 it is estimated that $27.9 billion will be spent on direct costs for CHF, $14.7 billion on hospital care, and $2.9 billion on drugs/other medical durables [1]. With hospital readmission rates as high as 50% at six months, and with the major medical society guidelines focused on the outpatient management of CHF, physicians are always looking for in