• Òscar Miró, Koji Takagi, Etienne Gayat, Pere Llorens, Francisco J Martín-Sánchez, Javier Jacob, Pablo Herrero-Puente, Víctor Gil, Desiree N Wussler, Fernando Richard, María L López-Grima, Cristina Gil, José M Garrido, María J Pérez-Durá, Aitor Alquézar, Héctor Alonso, Josep Tost, Francisco J Lucas Invernón, Christian Mueller, and Alexandre Mebazaa.
• Emergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Catalonia, Spain, University of Barcelona, Barcelona, Catalonia, Spain. Electronic address: omiro@clinic.cat.
• JACC Heart Fail. 2019 Oct 1; 7 (10): 834-845.

ObjectivesThis 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.BackgroundPatients 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.MethodsWe 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.ResultsWe 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.ConclusionsThere 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.Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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