RT Journal Article
T1 CORT-AHF Study: Effect on Outcomes of Systemic Corticosteroid Therapy During Early Management Acute Heart Failure.
A1 Miró, Òscar
A1 Takagi, Koji
A1 Gayat, Etienne
A1 Llorens, Pere
A1 Martín-Sánchez, Francisco J
A1 Jacob, Javier
A1 Herrero-Puente, Pablo
A1 Gil, Víctor
A1 Wussler, Desiree N
A1 Richard, Fernando
A1 López-Grima, María L
A1 Gil, Cristina
A1 Garrido, José M
A1 Pérez-Durá, María J
A1 Alquézar, Aitor
A1 Alonso, Héctor
A1 Tost, Josep
A1 Lucas Invernón, Francisco J
A1 Mueller, Christian
A1 Mebazaa, Alexandre
K1 acute heart failure
K1 corticosteroids
K1 dyspnea
K1 emergency department
K1 mortality
K1 outcome
AB This study investigated whether systemic corticosteroids (new onset) administered to patients with acute heart failure (AHF) have any association with outcomes, with differentiated analyses for patients with and without chronic obstructive pulmonary disease (COPD) as a comorbidity. Patients with undiagnosed dyspnea frequently receive corticosteroids in emergency departments while determining a final diagnosis, but their effect on the outcomes of patients with AHF without overt COPD exacerbation is unknown. We selected patients with AHF from the EAHFE (Epidemiology of Acute Heart Failure in the Emergency Departments) registry, recording key data (new-onset corticosteroid therapy, COPD condition). Patients with and without COPD were analyzed separately. We calculated unadjusted and adjusted ratios for corticosteroid-treated compared with corticosteroid-untreated patients for 2 coprimary endpoints: 90-day all-cause mortality (from index episode) and 90-day post-discharge combined endpoint (all-cause mortality or readmission for AHF), with intermediate time-point estimations. Other secondary endpoints were calculated, and some sensitive and stratified analyses were performed. We analyzed 11,356 patients: 8,635 without COPD (841 corticosteroid-treated, 9.7%) and 2,721 with COPD (753 corticosteroid-treated, 27.7%). There were several differences between treated and untreated patients, essentially because corticosteroid-treated patients were sicker. Although unadjusted outcomes were worse in corticosteroid-treated patients, especially in patients without COPD, these differences disappeared after adjustment: hazard ratios for 90-day mortality (without/with COPD) were 0.91 (95% confidence interval (CI): 0.76 to 1.10)/0.99 (95% CI: 0.78 to 1.26), and 1.09 (95% CI: 0.93 to 1.28)/1.02 (95% CI: 0.86 to 1.21) for the post-discharge combined endpoint. Analyses of intermediate time-point coprimary endpoints and secondary outcomes rendered similar estimations. Sensitivity and stratified analysis did not significantly modify these results. There is no evidence of harm related to the new onset of systemic corticosteroid therapy during an episode of AHF, either in patients with or without concomitant COPD.
YR 2019
FD 2019-09-11
LK http://hdl.handle.net/10668/14509
UL http://hdl.handle.net/10668/14509
LA en
DS RISalud
RD Jul 30, 2025