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Intravenous corticosteroids didn't hurt people with acute heart failure (HF), and had the potential to pay off in better outcomes for some in a hypothesis-generating study based on Spain's Epidemiology of Acute Heart Failure in the Emergency Departments (EAHFE) registry.

Whereas acute HF patients receiving corticosteroid therapy in the emergency department (ED) saw no improvement in all-cause mortality at 30 days, there was a trend of more favorable point estimates for survival in those with elevated C-reactive protein (CRP) levels.

Potential for an association between corticosteroid therapy and better outcomes was observed among people with the most inflammation, defined as CRP >40 mg/L -- findings that were nevertheless statistically non-significant based on the available data:

• All-cause mortality at 30 days: 11.8% with corticosteroids vs 19.4% without (HR 0.56, 95% CI 0.20-1.55)

• Post-discharge ED revisit at 30 days: 42.3% vs 43.8% (HR 0.92, 95% CI 0.52-1.62)

• In-hospital all-cause mortality: 8.8% vs 13.4% (HR 0.61, 95% CI 0.17-2.14)

"The present analysis suggests that corticosteroids might have the potential to improve outcomes in acute HF patients with inflammatory activation," wrote study authors Gad Cotter, MD, of Momentum Research in Chapel Hill, North Carolina, and colleagues in .

Inflammation has been linked to HF, though anti-inflammatory therapies have failed in chronic HF, the researchers said, citing the failures of infliximab and etanercept in the older and studies, respectively.

"Although corticosteroids have been classically viewed as anti-inflammatory agents, corticosteroids can cause sodium and water retention, potentially leading to worsening of HF. However, it has been reported that the administration of corticosteroids to patients with severe acute HF produced a potent diuretic effect and improved fluid overload and renal function," according to the investigators.

"Taken together with previous studies of potentially improved diuresis, the [present] results suggest that future randomized trials on anti-inflammatory therapy are needed to assess potential benefit in patients with the highest degree of inflammation," Cotter and co-authors emphasized.

EAHFE was a registry that included 45 Spanish EDs from 2007 to 2018.

For the present analysis, the investigators included 1,109 people (median age of 81.2, 45% of whom were men) with NT-proBNP >300 pg/mL and CRP >5 mg/L in the ED. The team excluded people taking chronic systemic corticosteroids and those who had had acute HF triggered by an infection.

Of the study cohort, 10.9% of patients received at least one IV bolus corticosteroid treatment.

This group tended to have higher systolic blood pressure, lower room air oxygen saturation, and were more likely to have cerebrovascular disease, peripheral artery disease, chronic obstructive pulmonary disease, and dementia. Their index acute HF episode was more commonly triggered by hypertensive crisis, compared with non-corticosteroid users.

The retrospective study was limited by the potential for confounding, a relatively small sample of corticosteroid users, and a lack of details regarding dose and duration of treatment in the database, Cotter and colleagues acknowledged.

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