Glucocorticoids for Patients With Acute Decompensated Heart Failure: A Protocol for a Systematic Review With Meta‐Analysis and Trial Sequential Analysis

BACKGROUND: Acute decompensated heart failure (ADHF) is associated with inflammation. Inflammatory biomarkers in patients with ADHF are associated with increased mortality. Glucocorticoids mitigate systemic inflammation and may therefore have a therapeutic role in ADHF. We aim to investigate the effects of adding glucocorticoids to standard of care in the treatment of ADHF. METHOD: This protocol for a systematic review with meta-analysis is conducted according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will conduct a systematic review of randomized clinical trials comparing glucocorticoids with placebo or any other control in patients hospitalized with ADHF. The primary outcome is all-cause mortality. Secondary outcomes include length of hospitalization, all-cause hospitalizations and rehospitalization for heart failure. A comprehensive search will be conducted across Medline, Embase, the Cochrane Central Register of Controlled Trials, the Latin American and Caribbean Literature on Health Sciences, and Web of Science, and Covidence will be used to independently screen all results by two authors. The search is planned to begin in April 2026. A meta-analysis and Trial Sequential Analysis will be conducted on eligible trials. Risk of bias will be evaluated using the Cochrane Risk of Bias tool-version 2. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). CONCLUSION: This systematic review and meta-analysis will synthesize the available randomized evidence on glucocorticoids as an adjunct to standard care in patients hospitalized with ADHF, with the aim of assessing their therapeutic potential in this population and identifying gaps to inform future research.