Hospitals' nesiritide use declines at different rates

Fewer hospitals now use nesiritide for heart failure due to safety concerns highlighted in 2005, and a study published in the August issue of the Journal of the American College of Cardiology: Heart Failure found that hospitals changed the way they use the drug in three distinct patterns. They categorized facilities as “low users,” “fast de-adopters” and “slow de-adopters,” but there were no significant differences between the groups in terms of hospital characteristics.

“Our current study was designed to extend prior work by evaluating the patterns of change among hospitals between 2005 and 2010,” wrote the authors, led by Chohreh Partovian, MD, PhD, of Yale University School of Medicine in New Haven, Conn. “We hypothesized that amid a continuing general decrease in nesiritide use, there would be a marked heterogeneity in the level and speed of de-adoption across hospitals, revealing various institutional responses to new information.”

The researchers analyzed data from the Premier database, which contains information from more than 330 million discharges from 620 hospitals across the country. For their study, they focused on data from 813,783 HF hospitalizations at 403 hospitals between 2005 and 2010.

The percentage of hospitals using nesiritide (Natrecor, Janssen) decreased from 15.4 percent in 2005 to 1.2 percent in 2010. Additional analysis revealed three patterns of change in the use of the drug. There were 302 hospitals in the “low user” group (75 percent of hospitals and 69 percent of all hospitalizations). Hospitals in this group had an average initial risk-standardized rate of 9 percent in 2005.

The “fast de-adopter” group consisted of 82 hospitals (20 percent of hospitals and 25 percent of hospitalizations). These hospitals had an average initial risk-standardized use rate of 26 percent in 2005. The “slow de-adopters” included 19 hospitals (5 percent of hospitals and 6 percent of all hospitalizations). The initial risk-standardized use rate was highest in this group at 38 percent in 2005.

In terms of hospital size, annual HF hospitalization volume and implantable cardioverter-defibrillator (ICD) capability, proportion of cardiologist who are attendings and proportion of Medicaid recipients did not significantly differ between the slow de-adopters and the other groups.

The fast de-adopters were more likely to be in the midwestern or southern U.S., to have ICD capability and to have more Medicaid patients when compared with low users.

The authors explained that their findings could be due to a number of factors that their study did not measure, such as the amount of pharmaceutical marketing.

“Our study further revealed that this initial, short-term strong response to new information was followed by a steady decrease in use over subsequent years, although at a more gradual level and speed,” they wrote.

Other studies have found similar patterns, and those studies “have suggested that adoption decisions of organizations are a function of both internal factors and external and social factors, but the relative importance of these factors changes over time as information diffuses among potential adopters.”