Background/Purpose: Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1).  Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities. The objective was to study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.

Methods: The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure.  Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.

Results: There were 35.8 million all-cause hospitalizations in patients in the US in 2017.  Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout.  These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%).  The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%).  The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 – $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion – $24.0 billion).

Conclusion: While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1).  This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.

References:

1. Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology 2019. doi:10.1001/jamacardio.2019.4187
2. Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gout-and-heart-failure-in-the-us/