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• W2044477044 abstract "Introduction: Acute Decompensated Heart Failure (ADHF) and Stage D HF patients have a high and variable mortality. Hypothesis: The Seattle HF Model (SHFM) will effectively risk stratify hospitalized patents and will lower the nesiritide hazard ratio. Methods: SHFM (Circ 9/09) was applied prospectively to 1,610 patients with ADHF (VMAC) or Stage D HF (FUSION-I & II) to determine the adjusted 30-day and 24 week mortality for nesiritide. Results: Hospitalized patients had 30-day hazard ratio (HR 2.11, p = 0.004) after adjustment for SHFM and inotrope use (HR) 1.42, p = 0.26) at 30 days. The SHFM in hospitalized patients was highly predictive for hospital death and 30-day mortality(p < 0.0001, ROC 0.76, 0.77), although the absolute risk was ∼double the estimate in ambulatory HF. The 30-day HR for nesiriditide adjusted for hospitalization was 1.54 (p = 0.12) and decreased to 1.42 (p = 0.20) after further adjustment with SHFM and inotrope use. The 30-day HR for nesiritide did not vary with SHFM. However, the 30-day HR for nesiritide varied based on the diuretic dose (p = 0.03), SBP (p = 0.05), EF (p = 0.07), and NYHA prior to hospitalization (p = 0.32). The nesiritide risk varied by diuretic dose quartiles (16, 69, 131, 360 furosemide mg/day), HR 2.3 (p = 0.20), 1.04 (p = 0.95), 0.57 (p = 0.26) and 3.12 (p = 0.04) respectively. We assigned 1 point for SBP≤130, EF≤40, NYHA 3/4 prior to hospitalization, and a daily furosemide dose 40-240 mg/day. There was a significant interaction of nesirtide with the risk score (p = 0.0004), with trend for nesiritide benefit with 4 points (hazard ratio 0.50, p = 0.048). The interaction is largely driven by harm for scores of ≤3 for both nesiriditide (HR 3.52, p = 0.01) and inotrope use (HR 2.18, p = 0.06). Nesiritide in all patients was not associated with risk at 24 weeks (adjusted HR 1.14, p = 0.29). Conclusions: The SHFM can be used to risk stratify hospitalized as well as chronic outpatients with heart failure. Nesiritide therapy may have a complex interaction with diuretic dose, EF, SBP, and NYHA. There may be benefit in NYHA 3/4 patients with systolic heart failure on moderate dose of diuretics, with potential harm in patients with higher EF, SBP, or minimal diuretics. This potential complex interaction should be prospectively tested in the ongoing large ASCEND-HF trial." @default.
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• W2044477044 date "2010-08-01" @default.
• W2044477044 modified "2023-09-25" @default.
• W2044477044 title "Potential Interaction of Nesiritide with Clinical Variables" @default.
• W2044477044 doi "https://doi.org/10.1016/j.cardfail.2010.06.228" @default.
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