Clinical Question: Is nesiritide (Natrecor) effective in the treatment of patients with congestive heart failure (CHF)?

Setting: Various (meta-analysis)

Study Design: Meta-analysis (randomized controlled trials)

Synopsis: Nesiritide improves symptoms in patients with acute CHF but long-term safety and efficacy are uncertain. The investigators obtained all registered controlled trials on file from the U.S. Food and Drug Administration and searched PubMed and abstracts from annual meetings of various cardiology and heart associations for additional studies.

Included studies were randomized double-blind group studies of nesiritide administered as a single infusion versus placebo that reported 30-day mortality rates. Only three trials with a total of 862 patients met all inclusion criteria. Although not statistically significant, the 30-day mortality rates were higher among patients in the nesiritide group (7.2 versus 4.0 percent;P = .059). There was no evidence for heterogeneity among the three trials. The investigators did not analyze the potential for publication bias to affect the results.

Bottom Line: Although it improves short-term symptoms, nesiritide may increase the risk of death at 30 days when used in the treatment of acute decompensated heart failure. This review should mandate a large-scale, adequately powered, randomized trial to definitively evaluate this treatment. (Level of Evidence: 1a–)