RANDOM CHF Rx NOTES

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					RANDOM CHF NOTES Readm: 20% in 1 mo, 50% in 6 mo. Mort: 12% in 1 mo, 33% in 1y, 50% in 5y. UNLOAD (JACC 07) Ultrafiltration vs diuretic rx. Less rehospitalization despite less wt loss. No diff in dyspnea. EVEREST (JAMA 07) Tolvaptan. No mort difference. Only benefit in SOB. Arginine vasopressin receptor in the kidneys only, not in the heart. Nesiritide: No vasodilator (NTG, nitropruss or nesiritide) has shown to decr mort in ADHF in random contr trial. Even nisiritide despite decreasing neurohorm activation. It did improve SOB comp to placebo but not comp to NTG (VMAC investigators JAMA 02;287). Risk of worsening renal failure, however at doses routinely used there was a trend toward worse renal outcomes but it was not significant. Higher doses did show a signif difference (J Card Fail 06;11 Abstract)


				
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posted:9/21/2008
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