Interleukin (IL)-1 Blockade in Acute Heart Failure (Anakinra ADHF)

Inclusion Criteria

• •All 5 criteria need to be met for enrollment of the patient in the study
• •1. Primary diagnosis of acute decompensated heart failure within the last 24 hours as evidenced by both of the following:
• •1. dyspnea or respiratory distress or tachypnea at rest or with minimal exertion
• •2. evidence of elevated cardiac filling pressure or pulmonary congestion (at least one of the conditions must be met);
• •i. pulmonary congestion/edema at physical exam OR chest x-ray; ii. plasma Brain Natriuretic Peptide (BNP) levels ≥200 pg/mL; iii.invasive measurement of left ventricular end-diastolic pressure \>18 mmHg or of pulmonary artery occluding pressure (wedge) \>16 mmHg.
• •2. Left ventricular systolic dysfunction (LVEF\<40%) during index hospitalization or prior 12 months.
• •3. Age ≥18 years old
• •4. Willing and able to provide written informed consent.
• •5. Screening plasma C-reactive protein levels \>5 mg/L.
• •1. The primary diagnosis for admission is NOT decompensated heart failure, including diagnosis of acute coronary syndromes, hypertensive urgency/emergency, tachy- or brady-arrhythmias.
• •2. Concomitant clinically significant comorbidities that would interfere with the execution or interpretation of the study including but not limited to acute coronary syndromes, uncontrolled hypertension or orthostatic hypotension, tachy- or brady-arrhythmias, acute or chronic pulmonary disease or neuromuscular disorders affecting respiration.
• •3. Recent (previous 3 months) or planned cardiac resynchronization therapy (CRT), coronary artery revascularization procedures, or heart valve surgeries.
• •4. Previous or planned implantation of left ventricular assist devices or heart-transplant.
• •5. Chronic use of intravenous inotropes.
• •6. Recent (\<14 days) use of immunosuppressive or anti-inflammatory drugs (not including Non-Steroidal Anti-Inflammatory Drugs \[NSAIDs\]).
• •7. Chronic inflammatory disorder (including but not limited to rheumatoid arthritis, systemic lupus erythematosus).
• •8. Active infection (of any type);
• •9. Chronic/recurrent infectious disease (including Hepatitis B virus \[HBV\], Hepatitis C virus \[HCV\], and HIV/AIDS).
• •10. Prior (within the past 10 years) or current malignancy.
• •11. Any comorbidity limiting survival or ability to complete the study.
• •12. End stage kidney disease requiring renal replacement therapy.
• •13. Neutropenia (\<2,000/mm3) or Thrombocytopenia (\<50,000/mm3).
• •14. Pregnancy.
• •15. Angina, arrhythmias, or electrocardiograph (ECG) changes that limit maximum exertion during cardiopulmonary exercise testing obtained during the baseline testing.