Background/Purpose: Acute gout arthropathy is a well-described side effect of aggressive diuresis in patients hospitalized with heart failure.  This study aims to determine the prevalence and predictors of acute gout attacks of patients admitted primarily for heart failure exacerbation as well as analyze its impact on health care resource utilization.

Methods: Data were obtained from the National Inpatient Sample (NIS) between 2009 and 2015. ICD-9-CM codes were captured to identify patients with a principal diagnosis of heart failure (ICD-9 428.x; 402.01, 402.11, 402.91; 404.01, 404.03, 404.11, 404.13, 404.91, 404.93) and a secondary diagnosis of acute gouty arthropathy (ICD-9 274.01). Outcomes measured were length of stay (LOS), inpatient total cost, and prevalence of acute kidney injury (ICD-9 584.x). Multivariable logistic regression was used to identify predictors of acute gout arthropathy.

Results: We identified a total of 1,130,374 patients ( >18years) who were admitted for heart failure exacerbation over the study period with 4116 (0.4%) having an acute gout attack during that admission. Patients who developed gout were younger (67.9 vs. 61.7 years, P-value < 0.001) and had a higher prevalence of alcohol abuse, iron deficiency anemia, coagulopathy, diabetes, and obesity (all P< 0.05). With regards to the observed outcomes, acute kidney injury (AKI) rates were higher in patients who developed acute gout attacks compared to those who did not (43.8% vs. 22.0%, P< 0.001). Total hospital cost ($ 9,999 vs.$ 6,941; P< 0.001) and LOS (6 days vs. 4 days; P< 0.001) were higher in patients that had acute gout attacks.Of the patients with acute gout and heart failure, only 8.9% of them received either an intra-articular joint injection or arthrocentesis. Multivariable logistic regression revealed that some significant predictors of gout were chronic kidney disease (OR 2.43; 95% CI 2.27-2.60; P-value < 0.001), chronic alcohol use (OR 1.27; 95% CI 1.08 -1.49; P-value < 0.004), Obesity (OR: 1.84; 95% CI 1.71-1.98; P-value < 0.0001), dyslipidemia (OR 1.16; 95% CI 1.09-1.24; P-value < 0.001).

Conclusion: Inpatient gout attacks result in an increment of days of hospital stay, AKI rates, and total charges in patients hospitalized with heart failure exacerbation. CKD, chronic alcohol use, obesity, and dyslipidemia showed a statistically significant increase in the risk of development of gouty arthritis flare in heart failure patients. Intra-articular injections or arthrocentesis were not commonly done in these patients per coding records. Our analysis indicates acute gout during a hospitalization for heart failure negatively impacts health care resource utilization.

« Back to 2019 ACR/ARP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/acute-gout-attacks-among-patients-admitted-due-to-heart-failure-analysis-of-nis-database/