Answer to the “Glucocorticoid therapy in patients with COVID-19 and concurrent heart failure” correspondence

Dear Director,

We are grateful for the comments on our article “Clinical characteristics and risk factors for mortality upon admission in patients with heart failure hospitalized due to COVID-19 in Spain.”¹ Indeed, glucocorticoid (GC) use was greater in patients with heart failure (HF) hospitalized for COVID-19 who died. This can be explained by the effects of the mineralocorticoid and sodium and water retention, as the letter’s authors correctly indicate.²

Unfortunately, we do not have specific data regarding the type of GC used; the only data recorded were whether they were used or not, the dose used, and the duration of treatment (SEMI-COVID-19 Registry).³ However, the following considerations should be noted:

First, the most used GC during the first wave of the epidemic in Spain was methylprednisolone, as a recent article indicated.⁴ Evidence on the reduction in mortality associated with the use of dexamethasone was not reported until later on⁵ and as such, it was used less in our country during the first wave.

Second, the initial multivariable analysis conducted in our study included patients’ baseline clinical variables at the time of admission and did not include variables regarding treatment administered. We are currently working on a larger, more focused database in order to discern the effect of treatment, including the use of GC (especially dexamethasone) on this profile of patient.

Lastly, and in contrast to the possible deleterious effect of GC in patients with HF, it should be noted that some recent works have demonstrated the utility of other drugs in patients with HF during hospitalization for COVID-19. Patients with HF who continued treatment with renin-angiotensin-aldosterone system inhibitors during hospitalization had lower in-hospital mortality rates than those who did not receive them or in whom they were suspended.⁶

In conclusion, according to our results, GC should be used with caution in patients with HF, weighing their risks and benefits. More prospective, controlled studies on the use of GC in patients with HF and COVID-19 are needed to confirm these results.