Outcomes of patients hospitalized for acute decompensated heart failure: does nesiritide make a difference?

<p>Abstract</p> <p>Background</p> <p>Nesiritide is indicated in the treatment of acute decompensated heart failure. However, a recent meta-analysis reported that nesiritide may be associated with an increased risk of death. Our goal was to evaluate the impact of nesiritide treatment on four outcomes among adults hospitalized for congestive heart failure (CHF) during a three-year period.</p> <p>Methods</p> <p>CHF patients discharged between 1/1/2002 and 12/31/2004 from the Adventist Health System, a national, not-for-profit hospital system, were identified. 25,330 records were included in this retrospective study. Nesiritide odds ratios (OR) were adjusted for various factors including nine medications and/or an APR-DRG severity score.</p> <p>Results</p> <p>Initially, treatment with nesiritide was found to be associated with a 59% higher odds of hospital mortality (Unadjusted OR = 1.59, 95% confidence interval [CI]: 1.31–1.93). Adjusting for race, low economic status, APR-DRG severity of illness score, and the receipt of nine medications yielded a nonsignificant nesiritide OR of 1.07 for hospital death (95% CI: 0.85–1.35). Nesiritide was positively associated with the odds of prolonged length of stay (all adjusted ORs = 1.66) and elevated pharmacy cost (all adjusted ORs > 5).</p> <p>Conclusion</p> <p>In this observational study, nesiritide therapy was associated with increased length of stay and pharmacy cost, but not hospital mortality. Randomized trials are urgently needed to better define the efficacy, if any, of nesiritide in the treatment of decompensated heart failure.</p

Art and the geometry of visual space

This chapter considers the geometric structure of visual space and the way it has been artistically depicted. This structure is hard to quantify using scientific methods and has not been precisely defined, in part because it is highly variable and subjective. But artists have often sought to record their visual experience and in doing so have rendered the structure of visual space in the objective form of paintings and drawings. Where audiences respond favourably to these artworks, it is in part because they recognise in them aspects of their own visual experience. Artworks, then, can serve as a source of data from which we derive evidence about the nature of visual space, and this in turn can inform scientific investigation of its geometry. It has been argued that linear perspective—a projective geometry discovered by artists and architects in fifteenth-century Italy—is the most accurate way to depict visual space. But although often trained in the techniques of linear perspective, artists have rarely applied its rules rigorously, and have instead developed various forms of ‘natural perspective’ that, it can be argued, are more effective at depicting visual space and so operate more effectively as works of art