Background/Purpose: Gout is the most common form of inflammatory arthritis and is caused by elevated serum uric acid (sUA). Elevated sUA is associated with worsened outcomes in patients with heart failure, however, little is known about the association between gout and acute heart failure (AHF). The objective of this study was to assess the impact of gout control on the rate of hospitalization for AHF in a prevalent gout population.

Methods: A retrospective analysis using the IMS Pharmetrics Plus database from 01/01/2009 to 12/31/2011. Patients were required to have evidence of “prevalent established gout” (ie, treated with urate-lowering therapy [ULT] or eligible for ULT based on American College of Rheumatology [ACR] guidelines) between 01/01/2009 and 12/31/2009, be aged ≥18 years on index date (01/01/2010), and have ≥1 sUA measurement reported during the year of evaluation of gout control status. Follow-up extended from 01/01/2010 to 12/31/2011. AHF rate was calculated as percentage of eligible patients having ≥1 AHF-related hospitalization over the course of calendar year 2011. In a given calendar year, patients were considered to have controlled gout if they had no elevated sUA (≥6 mg/dL), no diagnosis of tophus, and no flare documented, while uncontrolled gout was defined as ≥1 elevated sUA or ≥1 tophus diagnosis. The odds ratio (OR) of AHF was modeled using multivariable logistic regression adjusting for gout control status (in previous or current year), gender, age, and Charlson Comorbidity index as covariates.

Results: A total of 2,556 eligible gout patients with available sUA data in 2011 were identified in the US of which 67% had uncontrolled gout status (n=1,720). The unadjusted AHF hospitalization rates were 1.51% (95% confidence interval [CI]: 0.93%-2.09%) in patients with uncontrolled gout in 2011 and 0.72% (95% CI: 0.14%-1.29%) in patients with controlled gout. After adjusting for the covariates, AHF rate was significantly higher in patients whose gout was uncontrolled during the same year (adjusted OR: 2.66 [P=0.037]). Among the patients with available sUA data in 2010 (n=2,200), there was a trend indicating that patients with uncontrolled gout in 2010 were at higher risk of AHF hospitalization in 2011 (adjusted OR: 2.54 [P=0.059]).

Conclusion: This study suggests that patients with uncontrolled gout have a higher risk of being hospitalized for AHF. Further studies would be required to validate this finding on larger samples with availability of sUA data.