Burst Steroid Therapy and Quality of Life in Patients with Acute Heart Failure: Insights from the CORTAHF Trial

AIMS: Patients hospitalized with acute heart failure (AHF) treated with a 7 day prednisone course in the CORTAHF pilot trial had a greater improvement in health-related quality of life (QoL) at Day 7 in both the overall population and in patients with baseline interleukin 6 > 13 pg/mL. This post-hoc analysis examines the specific QoL domains and the relationship between clinical signs of congestion and QoL. METHODS: In the CORTAHF pilot trial, patients with AHF and high-sensitivity C-reactive protein (hsCRP) > 20 mg/L were randomized 1:1 to once-daily oral 40 mg prednisone for 7 days plus usual care or usual care alone. Patients completed the EQ-5D-5L, including the EQ-VAS, at baseline and Days 7 and 31. We estimated baseline-adjusted treatment effects on each of the five QoL dimensions and evaluated the interaction between baseline EQ-VAS and treatment effect on hsCRP change at Day 7 (the primary endpoint). The correlation between changes in signs of congestion and EQ-VAS were evaluated. RESULTS: Among 100 randomized patients, the improvement in QoL at Day 7 was driven by significant effects on the EQ-5D-5L mobility [win odds 1.48, 95% confidence interval (CI) 1.05-2.12] and usual activities (win odds 1.50, 95% CI 1.05-2.20) domains. The treatment effect on 7 day hsCRP change was independent of baseline EQ-VAS (interaction P = 0.13). Decongestion and EQ-VAS improvement were correlated (r = -0.528, P < 0.0001). CONCLUSIONS: In patients with AHF and high hsCRP levels, 7 day burst steroid therapy improved QoL mostly by affecting the mobility and usual activities domains. QoL improvement was correlated with decongestion and may therefore not be a direct effect of steroid therapy, but mediated through improvement in HF symptoms and signs. Inflammatory activation was reduced by prednisone irrespective of baseline EQ-VAS.