BNP Therapy Observation Unit Outcomes STudy (BOOST)
BNP Therapy Observation Unit Outcomes STudy (BOOST)
The investigators hypothesize that patients admitted to an emergency department (ED)
 observation unit will have a decreased rate of hospital admissions and ED recidivism when
 treated with nesiritide versus standard therapy. The investigators also hypothesize that
 decreasing B-type Natriuretic Peptide (BNP) levels during treatment in an ED observation unit
 will predict improved patient outcomes.
Congestive heart failure (CHF) is a growing problem in the United States. The increasing
 number of decompensated heart failure patients presenting to emergency departments (ED) for
 treatment is worsening the burden on already strained and limited health care resources. In
 addition, many of these patients will return to the ED for treatment within three months of
 being treated for decompensated heart failure. The emergence of ED observation units has
 provided a viable and cost effective alternative to inpatient treatment for many diseases
 including CHF. It has been shown that intensive, directed therapy in ED observation units has
 decreased the revisit rates for CHF patients. In addition, the introduction of nesiritide has
 shown promising results in the treatment of decompensated congestive heart failure.

 The primary aim of this study is to compare nesiritide versus standard heart failure therapy
 in an ED setting. A secondary aim is to determine if serial BNP levels during this
 observation unit stay will predict clinical outcomes.

 The treatment of heart failure in the ED places a tremendous burden on already limited
 resources. The costs of treatment as well as the morbidity and mortality associated with the
 disease are worsening and are predicted to increase as the general population ages. The
 ability to safely treat and discharge patients from an ED observation unit while reducing
 return visits would be invaluable in managing the growing number of heart failure patients.
Inclusion Criteria:

 -  Adult patient > 18 years of age

 -  Have a working diagnosis of HF, as determined by the emergency physician using the
 Boston Criteria. A score of 8-12 is required for inclusion in the study.

 -  Alert, oriented and able to provide informed consent.

 -  Able to be contacted by telephone for follow up after discharge, and have none of the
 study exclusion criteria.

 Exclusion Criteria:

 -  Dialysis Dependent Renal Failure

 -  Temperature > 38.5 degrees celsius

 -  Pneumonia (Infiltrates on Chest X-ray)

 -  Requiring IV vasoactive agents (Other than Nesiritide)

 -  Killip Class III/IV

 -  Systolic blood pressure < 90 mmHg

 -  EKG diagnostic or suggestive of Acute myocardial infarction or ischemia

 -  Abnormal Cardiac Markers

 -  Lack of a telephone

 -  Inability to provide informed consent due to cognitive impairment or a severe
 psychiatric disorder