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.
Schuller Gortney J, Porter KB. Risk of Death With Nesiritide. JAMA. 2005;294(8):897–898. doi:10.1001/jama.294.8.897-b
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