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August 24/31, 2005

Risk of Death With Nesiritide

JAMA. 2005;294(8):897-898. doi:10.1001/jama.294.8.897-b

To the Editor: In considering the results of the Review by Dr Sackner-Bernstein and colleagues,1 we are concerned that more than 50% of the analyzed patient data was from 1 trial, the VMAC.2 All of the trials analyzed included patients with acute heart failure, but the patients in VMAC were the most severely ill. Unlike PROACTION,3 both the VMAC and the NSGET had large percentages of patients with class III and IV heart failure (83% and 98%, respectively),4 but the VMAC trial also included patients with acute coronary syndromes.2 The VMAC study was considered the “real world” study and there was significantly greater concomitant use of dobutamine in the nesiritide group compared with the nitroglycerin group. Before and during hospitalization, patients in the VMAC’s nesiritide group also had a statistically significant greater use of class III anti-arrhythmics.