Background Both gout and hyperuricemia are associated with an increased risk of cardiovascular disease such as heart failure (HF). Recent data show that a history of gout and an acute episode of gout are risk factors for HF readmission and mortality.1
Objectives Our objective was to describe characteristics of patients with HF and gout and evaluate current practice patterns for acute and maintenance therapy for gout in the setting of HF exacerbation.
Methods Adult patients who were hospitalized for at least a day with primary diagnosis of HF at an academic medical center (2007-2010) were eligible (n=2,407). Of those, we reviewed the electronic medical records of 161 patients who had a serum uric acid level checked during the index hospitalization; individuals who had either history of gout or acute gouty flare during hospitalization were eligible. Patients with hematologic malignancies undergoing chemotherapy as well as in-hospital deaths were excluded. Data on demographic characteristics, admission and discharge date, comorbid conditions, serum uric acid level, and gout characteristics and treatment were analyzed.
Results A total of 74 patients, 16 with a new diagnosis of gout and 58 with a history of gout, were identified (see Table). Among the 58 patients with a history of gout, 22 (38%) developed a flare up during hospitalization. 30 (52%) of patients with a history of gout were on allopurinol, daily dosing ranged from 50mg to 600mg (median: 100mg). Nearly all patients (97%) on allopurinol had a serum uric acid level higher than 6.0mg/dl (median: 9.43mg/dl). 34% of patients who had acute gout during hospitalization had a polyarticular attack. Most patients had significant comorbidities such as diabetes (39%), chronic kidney disease (60%) and coronary artery disease (43%). Among the patients with an acute gout flare (n=38), common treatments were colchicine (53%) and/or oral corticosteroids (45%). Less than 10% received intra-articular steroid injections and none took an NSAID.
Conclusions Our study showed that almost all patients with gout and HF were hyperuricemic, most despite the use of allopurinol. Since the HF population is at high risk of gout attacks, more aggressive dose titration with uric acid lowering therapy may be warranted.
Thanassoulis G, Brophy J, Richard H, Pilote L. Gout, allopurinol use, and heart failure outcomes. Arch Intern Med. 2010;170(15):1358-1364.
Disclosure of Interest S. Kim Grant/Research support from: Pfizer, Takeda, D. Solomon Grant/Research support from: Pfizer, Amgen, BMS, Abbot