Resist the Urge to Give Nesiritide

May 2011

Resist the Urge to Give Nesiritide 

As a shareholder of common stock in Johnson and Johnson (J&J), the parent company of Scios (the company that markets nesiritide), I guess I should have been happy to read the headline "Trial: Nesiritide Safe for Acute Heart Failure" in the January 2011 ACEP NEWS.

However, as a physician who wants to do what is best for his patients, I must cynically ask why the headline did not read "Nesiritide: It May Not Do Any Good, but At Least It Won't Kill the Patient or Their Kidneys."

The story indicated that when a patient has acute decompensated heart failure, after trying nitrates and/or nitroprusside as vasodilators, as well as loop diuretics, at least nesiritide appears to not increase mortality or harm renal function when it is given to patients who are not already hypotensive.

I am troubled that the story made no mention of the efficacy of positive airway pressure techniques, nor of the fact that positive pressure provided with endotracheal intubation, while not without risks, can improve oxygenation and ventilation of patients with acute decompensated heart failure.

I am also concerned that this story will be used by some, such as the three physicians quoted in the story (Dr. Hernandez, Dr. Califf, and Dr. Jessup, all of whom have received financial support from either J&J or Scios) to attempt to justify expensive, noneffective treatment for a fairly frequent emergency condition. (I commend ACEP NEWS for noting the fact that all three of these doctors had a potential conflict of interest as regards nesiritide.)

Sometimes the most difficult but most appropriate thing for a doctor to do is to resist the temptation to "just do something." Doctors like to be able to order a drug and monitor for hoped-for effects. Unfortunately, as regards nesiritide, the best thing for doctors to do is to resist the urge to give a nonefficacious drug and look to the assistance of their respiratory therapist rather than to an ineffective pharmaceutical.

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