Long-term Prednisone Use for End-stage Heart Failure

Study Overview
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Brief Summary
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Patients with advanced (ACCF/AHA stage D) heart failure and hyperuricemia have high one-year mortality. Currently, there was no evidence-based therapy such as mechanically assisted circulatory support available in China. The investigators found glucocorticoid treatment such as prednisone could improve cardiac performance, potentiate renal responsiveness to diuretics in such patients. Therefore, it could be used as bridge therapy to help ACE inhibitors or beta blocker titration. With its help, most of the patients with stage D heart failure could be titrated to higher dose of ACE inhibitors and beta blockers during hospitalization. However, the efficacy of long-term, low-dose of prednisone use in such patients with limited life expectancy remain unclear. Therefore, the investigators designed this study to observe whether putting low-dose of prednisone on the patients with stage D heart failure for long term could further improve their survival. All patients will receive prednisone treatment during hospitalization and receive maximum tolerated guideline-directed medical therapy (GDMT). After discharge from hospital, the patients will be randomized to receive long-term, low-dose prednisone treatment or standard GDMT.

Official Title
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Long-term Prednisone Use in Patients With Advanced Heart Failure (ACCF/AHA Stage D) and Hyperuricemia

Conditions
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Heart Failure, Hyperuricemia

Intervention / Treatment
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* Drug: prednisone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Repeated (>2) hospitalizations or ED visits for HF in the past year Inability to exercise including exertion limited, exertion intolerance, resting symptoms or inotrope dependent Left ventricular ejection fraction ≤35% Serum uric acid level ≥500μmol/L Received prednisone treatment during hospitalization period and And more 5 of the followings Progressive deterioration in renal function (e.g., rise in BUN and creatinine) Weight loss without other cause (e.g., cardiac cachexia) Intolerance to ACE inhibitors due to hypotension and/or worsening renal function Intolerance to beta blockers due to worsening HF or hypotension Frequent systolic blood pressure <90 mm Hg Recent need to escalate diuretics to maintain volume status, often reaching daily furosemide equivalent dose >160 mg/d and/or use of supplemental thizide therapy Progressive decline in serum sodium, usually to <133 mEq/L Gastrointestinal symptoms (abdominal discomfort, nausea, poor appetite), disabling ascites, or severe lower-extremity edema Exclusion Criteria: Any condition (other than heart failure) that could limit the use of prednisone Any concurrent disease that likely limits life expectancy; Active myocarditis, or an hypertrophic obstructive or restrictive cardiomyopathy; Myocardial infarction, stroke, unstable angina, or cardiac surgery within the previous 3 months; Indication for hemodialysis Uncontrolled systolic blood pressure > 160 mmHg Complex congenital heart disease Poorly controlled diabetes

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Prednisone<br>Prednisone (10 to 20 mg/day, orally) combined with maximum tolerated guideline-directed medical therapy for at least 12 months. | Drug: prednisone<br>* Prednisone (10 to 20 mg/day, orally) combined with maximum tolerated guideline-directed medical therapy for at least 12 months<br>|
| No Intervention: Control<br>Maximum tolerated guideline-directed medical therapy | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality within 12 months |  | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Event-free survival time (defined as time to first hospitalization due to heart failure deterioration or death) within 12 months |  | 12 | 
| Survival time (defined as time to death) within 12 months |  | 12 months | 
| Change from baseline in serum uric acid |  | month 6 and month 12 | 
| Change from baseline in serum creatinine |  | month 6 and month 12 |