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Risk of Death With Nesiritide
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To the Editor: In their Review of the short-term risk of death after treatment with nesiritide for decompensated heart failure, Dr Sackner-Bernstein and colleagues1 found that the use of nesiritide may be associated with an increased risk of death. However, several factors other than nesiritide use may have significantly influenced their results.
The objective of this study was to investigate the safety of nesiritide relative to non–inotrope-based control therapies. However, the selection criteria used to achieve this goal may have biased the evaluation against nesiritide because the use of inotropic agents in patients receiving nesiritide was not precluded. In fact, inotrope use was greater in patients receiving nesiritide compared with control patients both before and during drug infusion. The authors failed to detect a statistically significant association between inotrope use and mortality requiring risk adjustment, but they only analyzed 1 trial and only 1 inotropic agent within that trial. Because . . . [Full Text of this Article]
Andrew J. Burger, MD
aburger@bidmc.harvard.edu
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston, Mass
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