Abstract 3145: Effect of Gout and Allopurinol Use on Heart Failure Outcomes
Background: Hyperuricemia is associated with reduced survival among heart failure (HF) patients but the effect of gout on HF outcomes is not known. A recent randomized trial suggested that allopurinol may reduce adverse outcomes among hyperuricemic HF patients. We sought to determine whether gout and allopurinol use are associated with heart failure outcomes.
Methods: Time-matched nested case-control analysis of a retrospective cohort of HF patients >65 years of age. The primary outcome was a composite outcome of HF readmission and all-cause mortality. Secondary outcome was all-cause mortality. Risk ratios were calculated using conditional logistic regression and adjusted for known prognostic factors.
Results: Of the 25,090 eligible patients, 14,327 patients experienced the primary outcome. Both a remote history of gout and an acute episode of gout (within 60 days of the event date) were associated with an increased risk of HF readmission/death (adjusted risk ratio [adj RR] 1.63, 95% confidence interval [CI] 1.48 –1.80; p<0.001 and adj RR 2.06, 95% CI 1.39 –3.06; p<0.001, respectively). Continuous allopurinol use (>30 days of continuous use) was not associated with HF outcomes among the overall HF population (adj RR 1.02, 95%CI 0.95–1.10, p=0.55) but was associated with reduced HF readmissions/death and all-cause mortality among HF patients with a history of gout (adj RR 0.66, 95% CI 0.56 – 0.77, p<0.001; adj RR 0.69, 95% CI 0.55– 0.86, p<0.001, for HF readmission/death and all-cause mortality, respectively).
Conclusions: HF patients with a history of gout represent a high risk population. Among such patients, the use of allopurinol is associated with improved outcomes.