Long-term Prednisone Use for End-stage Heart Failure

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 1. Progressive deterioration in renal function (e.g., rise in BUN and creatinine) 2. Weight loss without other cause (e.g., cardiac cachexia) 3. Intolerance to ACE inhibitors due to hypotension and/or worsening renal function 4. Intolerance to beta blockers due to worsening HF or hypotension 5. Frequent systolic blood pressure \<90 mm Hg 6. 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 7. Progressive decline in serum sodium, usually to \<133 mEq/L 8. 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