Use of Nesiritide Before and After Publications Suggesting Drug-Related Risks in Patients With Acute Decompensated Heart Failure

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Abstract
The adoption of evidence-based therapies for the treatment of cardiovascular diseases has been extensively studied in the clinical trials setting, registries, and claims data.1-6 The rapidity with which medications are accepted into clinical practice following the publication of positive trials data varies. For example, the uptake of some heart failure medications, such as angiotensin-converting enzyme (ACE) inhibitors was slow7-11 despite the publication of landmark studies12,13 and incorporation of the therapy into clinical practice guidelines.14 Conversely, the use of spironolactone increased significantly after release of the Randomized Aldactone Evaluation Study (RALES) trial data,15 with unexpected consequences.4,16