Author + information
- Received December 26, 2018
- Revision received April 2, 2019
- Accepted April 3, 2019
- Published online September 30, 2019.
- Òscar Miró, MD, PhDa,∗∗ (, )
- Koji Takagi, MDb,c,∗,
- Etienne Gayat, MD, PhDc,d,
- Pere Llorens, MD, PhDe,
- Francisco J. Martín-Sánchez, MD, PhDf,
- Javier Jacob, MD, PhDg,
- Pablo Herrero-Puente, MD, PhDh,
- Víctor Gil, MD, PhDa,
- Desiree N. Wussler, MDi,
- Fernando Richard, MDj,
- María L. López-Grima, MDk,
- Cristina Gil, MDl,
- José M. Garrido, MDm,
- María J. Pérez-Durá, MDn,
- Aitor Alquézar, MD, PhDo,
- Héctor Alonso, MD, PhDp,
- Josep Tost, MD, PhDq,
- Francisco J. Lucas Invernón, MDr,
- Christian Mueller, MDi and
- Alexandre Mebazaa, MD, PhDc,d
- aEmergency Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Catalonia, Spain, University of Barcelona, Barcelona, Catalonia, Spain
- bCardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
- cINSERM UMR-S 942, Paris, France
- dDepartment of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Paris, France
- eEmergency Department, Short-Stay Unit and Home Hospitalization, Hospital General de Alicante, Alicante, Spain
- fEmergency Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
- gEmergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Catalonia, Spain
- hEmergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- iCardiology Department, University Hospital Basel, Basel, Switzerland
- jEmergency Department, Hospital Universitario de Burgos, Burgos, Spain
- kEmergency Department, Hospital Doctor Peset, Valencia, Spain
- lEmergency Department, Hospital Universitario de Salamanca, Salamanca, Spain
- mEmergency Department, Hospital Virgen de la Macarena, Seville, Spain
- nEmergency Department, Hospital Universitario La Fe, Valencia, Spain
- oEmergency Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
- pEmergency Department, Hospital Marqués de Valdecilla, Santander, Spain
- qEmergency Department, Hospital de Terrassa, Catalonia, Spain
- rEmergency Department, Hospital Universitario de Albacete, Albacete, Spain
- ↵∗Address for correspondence:
Dr. Òscar Miró, Emergency Department, Hospital Clínic, Villarroel 170, 08036 Barcelona, Catalonia, Spain.
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.
↵∗ Drs. Miró and Takagi have equally contributed to this study and are co-first authors.
This study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER (PI15/01019, PI15/00773, PI18/00393, PI18/00456) and Fundació La Marató de TV3 (2015/2510). The “Emergencies: Processes and Pathologies” research group of the IDIBAPS has received financial support from the Catalonian Government for Consolidated Groups of Investigation (GRC 2009/1385 and 2014/0313). The ICA-SEMES (Research group on Acute Heart Failure of the Spanish Society of Emergency Medicine) Research Group has received unrestricted support from Orion Pharma and Novartis. Dr. Alquézar presently or in the past has consulted with Roche Diagnostic regarding high-sensitivity cardiac troponin assays. Dr. Gayat has consulted for Magnisense and Adrenomed. Prof. Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the European Union, the Kommission für Technologie & Innovation, the Stiftung für kardiovaskulär Forschung Basel, the University of Basel, the University Hospital Basel, Abbott, Beckman Coulter, Biomerieux, Brahms, Idorsia, Novartis, Ortho Clinical Diagnostics, Quidel, Roche, Sanofi, Siemens, Singulex, Sphingotec; and speaker honoraria/consulting honoraria from Acon, Amgen, AstraZeneca, Bayer, Biomerieux, Boehringer Ingelheim, BMS, Brahms, Novartis, Roche, Sanofi, Siemens, and Singulex. The present study has been designed, performed, analyzed, and written exclusively by the authors independently of these pharmaceutical companies. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 26, 2018.
- Revision received April 2, 2019.
- Accepted April 3, 2019.
- 2019 American College of Cardiology Foundation
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