Using the Nationwide Inpatient Database for trends studied between 1993 and 2011, investigators from Columbia University Irving Medical Center evaluated hospitalization outcomes among patients with heart failure and comorbid gout.
Findings from a new investigation of hospitalization outcomes among patients having a heart failure (HF) exacerbation who also have gout show that gout flares may be the primary driver behind these patients’ longer hospital length of stay (LOS), according to the study published in Therapeutic Advances In Musculoskeletal Disease.
Data on the patients for this retrospective cohort study were gleaned from electronic medical records at Columbia University Irving Medical Center. Patients with gout were identified by their having at least 2 International Classification of Diseases, Ninth Revision, and Tenth Revision codes for a gout diagnosis, and patients with HF were identified by at least 1 hospitalization between July 1, 2012, and June 30, 2017, with a primary discharge diagnosis of HF. For the study period, the investigators found 293 patients with gout who had 545 HF-related hospitalizations and 3798 patients with 5461 HF-related hospitalizations who did not have gout. The final analysis covered 246 patients in the study group and 492 matched controls (for both: mean [SD] age, 71.67 [13.95] years; 61.7% male).
“We aimed to compare the length of stay for patients with both gout and HF who were admitted for a primary diagnosis of HF exacerbation to those with HF without a gout diagnosis,” the authors wrote. “We hypothesized that patients admitted to the hospital for a primary HF exacerbation who then suffer a concomitant gout flare would likely have longer hospitalizations than those who do not experience concomitant gout flares.”
The study data show that the average ejection fraction in each group, 38.96% in the gout group and 36.97% in the nongout group, indicated most patients had HF with reduced ejection fraction. As well, the severity of their HF was indicated by alarmingly high brain natriuretic peptide (BNP) levels, which were 5145.41 mEq/L in the gout group and 5539.9 mEq/L in the nongout group. A higher BNP level is an indicator of greater HF severity.
Although hospital LOS was equal in the groups, at a median 6 days, the interquartile range was 2 days shorter in the nongout group. In addition, the log LOS was considered significantly longer in the gout vs nongout group: 1.86 (0.95) vs 1.72 (0.94).
Gout flares were confirmed in 13% of hospital admissions, and when there was a flare, HF hospitalizations were 10 days vs 6 days each for those with no flare and the control group. The group with a gout flare also had a longer log LOS vs patients who did not have gout: 2.41 (0.96) vs 1.72 (0.94).
Adjusting for such characteristics as age, kidney function, cardiac function, and socioeconomic status produced a significant association between gout flare and longer LOS (P < .0001). Although to a lesser degree, the investigators highlighted, history of nonflare gout was also associated with a longer hospital LOS (P = .04).
The predicted median LOS was highest, and close to twice as long among those who had gout and flared (10.96 days) compared with study participants who did not have gout (5.96 days).
Additional study findings show that at baseline, most patients in the gout cohort had Medicare coverage (51.2%), while commercial insurance was the most common coverage in the nongout group (49.4%); overweight was the most common weight classification, with the average body mass indices being 29.04 and 28.28, respectively; the control group had more pronounced chronic kidney disease, with a baseline creatinine of 2.22 vs 1.76 mEq/L; and elevated troponin was more common in the control group, at 22.6% vs 15.9%.
“Interventions that aim to improve gout outcomes and diminish the preponderance of flares in this high-risk population are warranted,” the study authors concluded.
Future areas of study that the authors focused their attention on were the evaluation of factors not studied herein that may increase the risk of a gout flare in patients with HF and addressing patient, provider, and health care system barriers that may lead to inadequate gout management.
DeMizio D, Wu G Wei Y, Bathon J, Wang R. Gout increases length of stay in patients hospitalized for heart failure exacerbation. Ther Adv Musculoskelet Dis. Published online June 14, 2022. doi:10.1177/1759720X221102853