Outpatient CHF clinics using Natrecor is causing controversy
UptoDate has this to say about the use of Natrecor:

We believe that nesiritide can be used safely and effectively in selected patients, particularly those who also require inotropic support. However, a randomized controlled trial specifically designed to compare the effects of noninotropic vasodilators and nesiritide will be required to clarify the precise indications for nesiritide therapy.

The use of nesiritide should be limited to patients who are hospitalized for severe HF (but not in cardiogenic shock) and in whom oral medical therapy has proven insufficient to control an acute exacerbation. Close monitoring of patient hemodynamics, urine output, and renal function are necessary for effective clinical use and safety.

The point of controversy is that results from randomized studies show an almost-significant increase in mortality within 30 days. However, this is the matter of continued study. Despite this point, some say the company is aggressively promoting its use in the name of increasing revenue:

The Scios Inc. reps gave Brown tips on how to set up and publicize outpatient clinics and even provided marketing brochures. ”You can turn it into a profit center,” Brown remembers them saying.