Intermittent Outpatient Use of Nesiritide Reduces Hospitalizations in Patients with Advanced Congestive Heart Failure

Abstract

Background: Among people older than age 65, heart failure (HF) is the most common Medicare diagnosis-related group (DRG) as well as the most expensive. Hospitalizations for HF continue to increase and account for close to 1 million hospitalizations annually. Nesiritide (human B-type natriuretic peptide, BNP) is approved for the treatment of patients with acutely decompensated CHF is used in our clinic to manage advanced HF patients. We wanted to evaluate the potential of this out patient therapy added to standard care in reducing hospitalization rates in this population. Methods: This was a retrospective evaluation of 65 patients treated in our clinic with nesiritide who were initially NYHA Class III/IV on maximally tolerated standard care with a poor quality of life. Patients received nesiritide 1–3 times a week as a 2-mcg/kg bolus followed by a 4-hour infusion at 0.01-mcg/kg/min. Patients were on Natrecor between 4 and 77 weeks. The number of days hospitalized in the year prior to starting nesiritide was compared to the number of days hospitalized since beginning nesiritide therapy. Results: 65 patients received intermittent treatment with nesiritide for 4 to 77 weeks (mean treatment time 33 weeks). Patients were predominantly male (66%) and Caucasian (89%). To date, 50 patients are still on nesiritide therapy. In the year prior to starting nesiritide therapy the average number of hospital days was 6.1±7.2 (median 4.0 days). After beginning nesiritide treatment the average number of days hospitalized was reduced to 0.4±1.3 days (median 0 days). This was a reduction of 5.7 days/patient/year±7.0 days (median reduction 4 days/patient/year), or 94%. Conclusions: Outpatient serial treatment with nesiritide resulted in significant reduction in hospital days.