Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
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.
Rifkin W. Nesiritide vs Nitroglycerin for Decompensated Congestive Heart Failure. JAMA. 2002;288(5):571-573. doi:10.1001/jama.288.5.571