Use of nesiritide in the management algorithm of acute decompensated heart failure

Acute decompensated heart failure (ADHF) is an emerging component of heart failure that is incompletely understood, lacks clear pathophysiologic mechanisms, is associated with worrisome outcomes, and is confounded by only minimally effective treatment options. Currently, treatment is targeted toward abnormal hemodynamics and includes diuretics, vasodilators, and inotropes. Nesiritide (B-type natriuretic peptide), represents a novel therapeutic option for ADHF that lowers elevated filling pressures and improves dyspnea. However, the risk/benefit ratio represents an unresolved issue, as important questions persist regarding drug-related morbidity and mortality. More research is needed to address safety, identify the ideal clinical scenario, and to resolve the absence or presence of drug associated risks.