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Cardiac outcome prevention effectiveness of glucocorticoids in acute decompensated heart failure: COPE-ADHF study
1Heart Center, The First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, China.
Insights
Glucocorticoid therapy in acute decompensated heart failure (ADHF) showed improved renal function and reduced cardiovascular death. This treatment appears safe for short-term use in ADHF patients.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Emerging evidence suggests glucocorticoids enhance natriuretic peptide action.
- This potentiation can improve renal function and diuresis in acute decompensated heart failure (ADHF).
Purpose of the Study:
- To evaluate the efficacy and safety of glucocorticoid therapy in ADHF patients.
- To assess the impact on serum creatinine and short-term cardiovascular mortality.
Main Methods:
- 102 ADHF patients were randomized to glucocorticoids or standard care.
- Primary endpoints included change in serum creatinine and 30-day cardiovascular death.
- Study terminated early due to enrollment challenges.
Main Results:
- Glucocorticoid therapy was well-tolerated and led to significant serum creatinine reduction (-0.14 mg/dL vs. -0.02 mg/dL).
- A significant reduction in 30-day cardiovascular death was observed (OR 0.26).
- Improvements in dyspnea and global clinical status were noted.
Conclusions:
- Short-term glucocorticoid therapy appears safe for ADHF patients.
- Glucocorticoid therapy did not worsen heart failure.
- Further research is warranted due to limited data.
Introduction:
Newly emerging evidence showed that glucocorticoids could potentiate natriuretic peptides' action by increasing the density of natriuretic peptide receptor A, leading to a potent diuresis and a renal function improvement in patients with acute decompensated heart failure (ADHF). Therefore, glucocorticoid therapy may be used in patients with ADHF.
Methods:
One hundred two patients with ADHF were randomized to receive glucocorticoids or standard treatment. Change from baseline in serum creatinine (SCr) at day 7 and cardiovascular death within 30 days were recorded. The study was terminated early because of slow site initiation and patient enrolment.
Results:
Glucocorticoid therapy seemed to be well tolerated. There was a remarkable SCr reduction after 7 days treatment. The change from baseline in SCr is -0.14 mg/dL in glucocorticoid group versus -0.02 mg/dL in standard treatment group (P < 0.05). Although sample size is limited, a cardiovascular death reduction at 30 days was observed in glucocorticoid group with odds ratio of 0.26 (3 deaths in glucocorticoid vs. 10 deaths in standard treatment group, P < 0.05). The survival benefit associated with glucocorticoid therapy persisted during the follow-up. Patient-assessed dyspnea and physician-assessed global clinical status were also improved in glucocorticoid group.
Conclusions:
Limited data indicate that glucocorticoid therapy may be used safely in patients with ADHF in short term. Glucocorticoid therapy did not cause heart failure deterioration. Further investigations are warranted.
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