This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on Web of Science (2)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Young and the Vasodilation in the Management of Acute [congestive heart failure] CHF (VMAC) investigators¹ found that, among patients with decompensated CHF, nesiritide resulted in only a 2-mm improvement in pulmonary capillary wedge pressure (PCWP) compared with nitroglycerin and a 4-mm improvement compared with placebo at both 3 and 24 hours. Although they claimed nesiritide improves hemodynamic function, this small change is of no clinical significance. Subjective dyspnea, as well as all other parameters, were not different between the groups. At 7 days, there were 4 deaths in the nesiritide group and 1 death in the nitroglycerin group, as well as a 4% greater 6-month mortality with nesiritide. The similar baseline characteristics argue against the differences being due to sicker patients randomized to nesiritide. Another recent study of nesiritide² also showed minimal improvement, but in the presence of significant and persistent hypotension.

As a clinician, I . . . [Full Text of this Article]

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Intravenous Nesiritide vs Nitroglycerin for Treatment of Decompensated Congestive Heart Failure: A Randomized Controlled Trial
Publication Committee for the VMAC Investigators
JAMA. 2002;287(12):1531-1540.
ABSTRACT | FULL TEXT