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Study Points to Improved Treatment for Heart Failure

05/20/02
by Alicia Di Rado
USC CARDIOLOGISTS have helped show that a new therapy for life-threatening heart failure results in a shorter course of treatment, less risk of rehospitalization and a lower mortality rate than does another drug frequently given for the disorder.

Results of a 46-center study showed that nesiritide, a synthesized form of a chemical naturally present in the body, offers significant benefits over dobutamine, a commonly administered but problematic drug for patients with decompensated heart failure.

The study was published in the March 6 issue of the Journal of the American College of Cardiology.

Patients at USC University Hospital and LAC+USC Medical Center accounted for a large proportion of participants in the study.

In patients with heart failure, the heart cannot pump blood efficiently enough to meet the needs of the body's other organs, said Uri Elkayam, professor of medicine at the Keck School of Medicine, director of the Heart Failure Program at USC and one of the study's co-authors.

That could happen because of coronary artery disease, high blood pressure, weakness of the heart muscle (cardiomyopathy) or other factors. Acutely decompensated heart failure occurs when a heart failure patient is overloaded with fluids in the body.

"Heart failure accounts for nearly 900,000 admissions to hospitals in the United States every year, and is the secondary diagnosis in another 1.8 million," Elkayam said. These patients typically feel out of breath, cannot lie flat in bed, have difficulty exercising and experience swelling (edema) in the legs or ankles, to the point of going to the hospital.

MORE THAN 300 patients participated in the study and were given either nesiritide or dobutamine for heart failure. Researchers found that patients who were given dobutamine stayed on the drug for at least a day longer than patients who got nesiritide.

About 4 percent of nesiritide-treated patients were readmitted for congestive heart failure within 21 days, lower than the 13 percent of dobutamine-treated patients. In addition, the mortality rate after six months was lower for nesiritide-treated patients than for dobutamine-treated patients.

"Dobutamine is often associated with increased heart rate and even serious arrhythmias, but nesiritide is associated with significantly fewer arrhythmias," Elkayam said. "It does not have the same potential for risk as dobutamine."