Efficacy and Safety of Steroids in Acute Heart Failure: A Systematic Review and Meta-analysis

Persistent congestion in acute heart failure (AHF) is associated with worse clinical outcomes. The use of steroids may provide therapeutic benefits by alleviating congestion, overcoming diuretic resistance, and mitigating the harmful effects of neurohormonal activation. This approach could potentially improve hemodynamic status and support better management of AHF, ultimately leading to enhanced patient recovery and reduced complications.

To evaluate the efficacy and safety of steroids in acute heart failure (AHF) as compared to the standard of care (SOC).

We used PubMed, Scopus, Google Scholar, and a manual search to identify Randomized controlled trials published up to October 15, 2024.The protocol was registered in PROSPERO (CRD42024601261).

All full-text randomized control trials (RCTs) that investigated steroids in heart failure were included. Results were pooled, where appropriate, using a random-effects model.

Three RCTs with 563 participants [282 Steroid, 281 (SOC)] were identified. No statistically significant difference is seen in mortality as well as NT-proBNP levels between the steroid plus SOC and control group (RR=0.59, 95% CI=0.06-6.13, p=0.66, (I⊃2;=51%, p=0.15) and (MD=0.14, 95% CI=-0.62 to 0.90, p=0.71, I⊃2;=91%, p<0.0006), respectively.

Steroids have no significant effect on all-cause mortality or NT-proBNP levels in patients with AHF.