CORT-AHF Study Effect on Outcomes of Systemic Corticosteroid Therapy During Early Management Acute Heart Failure
Por:
Miro, O, Takagi, K, Gayat, E, Llorens, P, Martin-Sanchez, FJ, Jacob, J, Herrero-Puente, P, Gil, V, Wussler, DN, Richard, F, Lopez-Grima, ML, Gil, C, Garrido, JM, Perez-Dura, MJ, Alquezar, A, Alonso, H, Tost, J, Invernon, FJL, Mueller, C, Mebazaa, A
Publicada:
1 oct 2019
Resumen:
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.
Filiaciones:
Miro, O:
Inst Invest Biomed August Pi & Sunyer, Hosp Clin, Emergency Dept, Barcelona, Catalonia, Spain
Univ Barcelona, Barcelona, Catalonia, Spain
Takagi, K:
Musashi Kosugi Hosp, Cardiol & Intens Care Unit, Nippon Med Sch, Kawasaki, Kanagawa, Japan
INSERM, UMR S 942, Paris, France
Gayat, E:
INSERM, UMR S 942, Paris, France
St Louis Univ Hosp, AP HP, Dept Anaesthesiol & Crit Care Med, Paris, France
Lariboisiere Univ Hosp, AP HP, Dept Anaesthesiol & Crit Care Med, Paris, France
Llorens, P:
Hosp Gen Alicante, Emergency Dept, Short Stay Unit & Home Hospitalizat, Alicante, Spain
Martin-Sanchez, FJ:
Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Lhospitalet De Llobregat, Catalonia, Spain
Herrero-Puente, P:
Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Spain
Gil, V:
Inst Invest Biomed August Pi & Sunyer, Hosp Clin, Emergency Dept, Barcelona, Catalonia, Spain
Univ Barcelona, Barcelona, Catalonia, Spain
Wussler, DN:
Univ Hosp Basel, Cardiol Dept, Basel, Switzerland
Richard, F:
Hosp Univ Burgos, Emergency Dept, Burgos, Spain
Lopez-Grima, ML:
Hosp Doctor Peset, Emergency Dept, Valencia, Spain
Gil, C:
Hosp Univ Salamanca, Emergency Dept, Salamanca, Spain
Garrido, JM:
Hosp Virgen Macarena, Emergency Dept, Seville, Spain
Perez-Dura, MJ:
Hosp Univ La Fe, Emergency Dept, Valencia, Spain
Alquezar, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Catalonia, Spain
Alonso, H:
Hosp Marques Valdecilla, Emergency Dept, Santander, Spain
Tost, J:
Hosp Terrassa, Emergency Dept, Catalonia, Spain
Invernon, FJL:
Hosp Univ Albacete, Emergency Dept, Albacete, Spain
Mueller, C:
Univ Hosp Basel, Cardiol Dept, Basel, Switzerland
Mebazaa, A:
INSERM, UMR S 942, Paris, France
St Louis Univ Hosp, AP HP, Dept Anaesthesiol & Crit Care Med, Paris, France
Lariboisiere Univ Hosp, AP HP, Dept Anaesthesiol & Crit Care Med, Paris, France
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