CORT-AHF Study Effect on Outcomes of Systemic Corticosteroid Therapy During Early Management Acute Heart Failure

Miro, Oscar and Takagi, Koji and Gayat, Etienne and Llorens, Pere and Martin-Sanchez, Francisco J. and Jacob, Javier and Herrero-Puente, Pablo and Gil, Victor and Wussler, Desiree N. and Richard, Fernando and Lopez-Grima, Maria L. and Gil, Cristina and Garrido, Jose M. and Perez-Dura, Maria J. and Alquezar, Aitor and Alonso, Hector and Tost, Josep and Lucas Invernon, Francisco J. and Mueller, Christian and Mebazaa, Alexandre. (2019) CORT-AHF Study Effect on Outcomes of Systemic Corticosteroid Therapy During Early Management Acute Heart Failure. JACC-HEART FAILURE, 7 (10). pp. 834-845.

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Official URL: https://edoc.unibas.ch/77030/

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OBJECTIVES 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.BACKGROUND 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.METHODS 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.RESULTS 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.CONCLUSIONS 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. (C) 2019 by the American College of Cardiology Foundation.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Müller, Christian and Miro, Oscar
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:18 Aug 2020 16:58
Deposited On:18 Aug 2020 16:58

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