I would like to commend Dee Fontana on her well-written and informative article, “Nesiritide: The Latest Drug for Treating Heart Failure” (February 2006:39–47). I think it is important to mention that the use of inotropic agents (ie, dobutamine and milrinone) in heart failure is associated with increased mortality.1 In addition, the use of the Trendelenburg position is probably not indicated and may be harmful in hypotensive patients.2 

I would like to thank the reader for his comments. Although I did indicate that inotropic medications have been shown to cause a statistically significant increase in lethal arrythymias in the OPTIME trial, I did not specifically state that they increase mortality. In fact, there was a trend toward increased mortality at 60 days in the OPTIME trial, (10.3% in the milrinone group and 8.9% in the placebo group); however, that difference was not statistically significant. Although there is a disturbing...

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