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Randomized Controlled Trial
. 2024 Oct;26(10):2282-2292.
doi: 10.1002/ejhf.3452. Epub 2024 Aug 30.

Burst steroid therapy for acute heart failure: The CORTAHF randomized, open-label, pilot trial

Gad Cotter  1   2   3 , Beth A Davison  1   2   3 , Yonathan Freund  4   5 , Adriaan A Voors  6 , Christopher Edwards  3 , Maria Novosadova  3 , Koji Takagi  3 , Hamlet Hayrapetyan  7 , Andranik Mshetsyan  8 , Drambyan Mayranush  9 , Alain Cohen-Solal  1   10 , Jozine M Ter Maaten  6 , Jan Biegus  11 , Piotr Ponikowski  11 , Gerasimos Filippatos  12 , Ovidiu Chioncel  13 , Malha Sadoune  1 , Matteo Pagnesi  14 , Tabassome Simon  4 , Marco Metra  15 , Douglas L Mann  16 , Alexandre Mebazaa  1   17
Affiliations
Free article
Randomized Controlled Trial

Burst steroid therapy for acute heart failure: The CORTAHF randomized, open-label, pilot trial

Gad Cotter et al. Eur J Heart Fail. 2024 Oct.
Free article

Abstract

Aims: Burst steroid therapy, effective in acute respiratory diseases, may benefit patients with acute heart failure (AHF) in whom inflammatory activation is associated with adverse outcomes.

Methods and results: CORTAHF assessed whether burst steroid therapy reduces inflammation and results in better quality of life and clinical outcomes in AHF. Patients with AHF, N-terminal pro-B-type natriuretic peptide >1500 pg/ml, and high-sensitivity C-reactive protein (hsCRP) >20 mg/L were randomized 1:1 to oral, once daily 40 mg prednisone for 7 days or usual care, without blinding. Patients were followed for 90 days. A total of 101 patients were randomized. At day 7 the primary endpoint, hsCRP decreased in both arms - adjusted geometric mean ratios (GMRs) were 0.30 and 0.40 in the prednisone and usual care arms (ratio of GMRs 0.75, 95% confidence interval [CI] 0.56-1.00, p = 0.0498). The 90-day risk of worsening heart failure (HF), HF readmission or death as reported by the unblinded investigators was significantly lower in the prednisone group (10.4%) than in usual care (30.8%) (hazard ratio 0.31, 95% CI 0.11-0.86, p = 0.016). The EQ-5D visual analogue scale score as reported by the unblinded patients increased more in the prednisone group on day 7 (least squares mean difference 2.57, 95% CI 0.12-5.01 points, p = 0.040). All effects were statistically significant in the pre-specified subgroup with centrally-measured interleukin-6 >13 pg/ml. Adverse events, particularly hyperglycaemia, occurred more in the prednisone group with no difference in infection rate.

Conclusion: In this small open-label study of patients with AHF, burst steroid therapy was associated with reduced inflammation as measured by hsCRP levels at day 7 (primary endpoint). Secondary endpoints showed improved quality of life at day 7 and reduced 90-day risk of death or worsening HF. Large prospective studies are needed to evaluate these findings.

Keywords: Acute heart failure; Corticosteroids; Quality of life; Worsening heart failure.

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References

    1. Elster SK, Braunwald E, Wood HF. A study of C‐reactive protein in the serum of patients with congestive heart failure. Am Heart J 1956;51:533–541. https://doi.org/10.1016/0002‐8703(56)90099‐0
    1. Markousis‐Mavrogenis G, Tromp J, Ouwerkerk W, Devalaraja M, Anker SD, Cleland JG, et al. The clinical significance of interleukin‐6 in heart failure: Results from the BIOSTAT‐CHF study. Eur J Heart Fail 2019;21:965–973. https://doi.org/10.1002/ejhf.1482
    1. Habibi D, Daneshpour MS, Asgarian S, Kohansal K, Hadaegh F, Mansourian M, et al. Effect of C‐reactive protein on the risk of heart failure: A Mendelian randomization study. BMC Cardiovasc Disord 2023;23:112. https://doi.org/10.1186/s12872‐023‐03149‐3
    1. Kalogeropoulos AP, Tang WHW, Hsu A, Felker GM, Hernandez AF, Troughton RW, et al. High‐sensitivity C‐reactive protein in acute heart failure: Insights from the ASCEND‐HF trial. J Card Fail 2014;20:319–326. https://doi.org/10.1016/j.cardfail.2014.02.002
    1. Boulogne M, Sadoune M, Launay JM, Baudet M, Cohen‐Solal A, Logeart D. Inflammation versus mechanical stretch biomarkers over time in acutely decompensated heart failure with reduced ejection fraction. Int J Cardiol 2017;226:53–59. https://doi.org/10.1016/j.ijcard.2016.10.038

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