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August 7, 2002

Nesiritide vs Nitroglycerin for Decompensated Congestive Heart Failure

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(5):571-573. doi:10.1001/jama.288.5.571

To the Editor: I have 3 concerns about the study by Dr Young and the VMAC investigators.1 First, patients were not adequately randomized. Six (32%) of the 19 baseline characteristics in Table 1 are statistically and perhaps clinically significantly different between treatment groups. These include underlying clinical status, such as baseline use of intravenous pressors (2.5-fold difference between groups). The authors did not address or control for such variation other than to state that the primary outcome, greater reduction in PCWP in the nesiritide group, was also found in patients who were not receiving pressors at baseline. Although pressor use may not have directly confounded the results, it is still likely that the 2 treatment groups were not equivalent.

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