Acute decompensated heart failure (ADHF) accounts for over one million U.S. hospital admissions annually. Nesiritide is the first new medication for ADHF in over 10 years. Due to its high cost, administration restrictions/monitoring, and limited evidence of efficacy other than ADHF, it is important to evaluate nesiritide utilization.

Purpose: This DUE investigated compliance with Wesley Medical Center’s nesiritide administration/monitoring guidelines.

Methodology: All patients receiving nesiritide from Mar 2004 to Feb 2005, 115 cases, were evaluated. Data points included: patient characteristics, ordering prescriber, indication, dosing, duration of therapy, presence of contraindications, ADR’s, concomitant medications, overall adherence to hospital criteria, cost information, length of ICU stay, length of hospital stay, discharge disposition, mortality rate, and 30-day readmission rate.

Results: Preprinted orders were utilized in 77% of patients (89/115). Even with preprinted orders, administration criteria were completely addressed in only 56% of patients (50/89). Primary prescribers were nephrology (46%), cardiology (28%), and cardiovascular surgery (18%). Primary reasons for use were ADHF (35%), no indication (25%), and renal failure (22%). Twenty-eight percent of patients had BNP < 400 or no levels ordered; and 31 patients had BNP levels obtained while receiving nesiritide. The most common ADR was SBP < 90 (51%). Twenty-one percent had contraindications prior to administration. Average ICU stay was 11.7±8.16 days; total hospital stay was 15.8±10.7 days. All-cause in-hospital mortality rate was 21%. A total of 510 infusions were prepared costing $215,944.

Conclusions: This DUE demonstrates that a high percentage of nesiritide usage is outside the facility’s Pharmacy and Therapeutics Committee guidelines.