Nesiritide in patients hospitalized for acute heart failure: does timing matter? Implication for future acute heart failure trials.

European Journal of Heart Failure
Yee Weng WongAdrian F Hernandez

Abstract

It remains unclear if early administration of i.v. nesiritide in patients hospitalized with acute heart failure (AHF) is associated with improved clinical outcomes. We analysed data from 7007 patients enrolled in ASCEND-HF to examine the associations between time to treatment with study medication (nesiritide or placebo) and clinical endpoints: (i) moderate to marked dyspnoea relief on a 7-point Likert scale at 6 h; (ii) 30-day all-cause mortality or re-hospitalization; and (iii) 30-day all-cause mortality. The median time to study drug administration was 16.7 h (25th, 75th percentiles = 6.5, 23.1), with significant regional variation (e.g. median of 13.0 h in Asia-Pacific vs. 18.4 h in North America). After risk adjustment, each hour delay in study medication after the first 10 h from initial hospital presentation was associated with modestly reduced odds of dyspnoea relief [(adjusted odds ratio (OR) 0.98, 95% confidence interval (CI) 0.98-0.99; P < 0.0001]. Every hour delay in study medication was associated with modestly higher all-cause mortality or re-hospitalization (unadjusted OR 1.01, 95% CI 1.01-1.02; P < 0.001) due to pre-randomization therapies and known predictors of 30-day outcomes (adjusted P = 0.12). There was no...Continue Reading

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Citations

Jul 13, 2016·International Journal of Cardiology·Yuya MatsueSteven R Goldsmith
Aug 23, 2019·The New England Journal of Medicine·Marco MetraUNKNOWN RELAX-AHF-2 Committees Investigators
Apr 14, 2017·The New England Journal of Medicine·Milton PackerUNKNOWN TRUE-AHF Investigators
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Mar 5, 2019·Current Heart Failure Reports·Anna Marie ChangSean P Collins
May 26, 2017·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Yuya MatsueSteven R Goldsmith

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