Gout May Predict Readmission Risk, Days in Hospital for Patients With Acute Coronary Syndrome

Gout was associated with longer hospital stays and a greater likelihood of readmission because of heart failure in patients with acute coronary syndrome (ACS), according to study data published in Arthritis Rheumatology.

The investigators abstracted data from the Coronary Disease Cohort Study, which enrolled patients with ACS from hospitals in New Zealand. Baseline clinical data were captured at the index hospital admission and at a postdischarge visit, which took place at a median of 32 days post-ACS. Baseline data included demographic information, cardiovascular risk factors, serum urate (SU) levels, and the presence of gout. Outcome measures included all-cause mortality and time to readmission for a cardiac ischemic event or heart failure. Cox proportional regression models were used to generate hazard ratios (HRs) for the following time-to-event measures: time to death, time to first readmission for a cardiovascular event, and time to first readmission for heart failure.

The present analysis used data from 1514 participants, among whom 160 (10.6%) had gout. The median (interquartile range) follow-up was 4.93 (3.65-6.74) years. During the follow-up period, 33.1% of patients with gout and 22.0% of patients without gout died. After adjusting for other factors associated with mortality, no significant difference in mortality risk was observed between patient groups (adjusted HR, 0.98; 95% CI, 0.69-1.38). A shorter time to readmission for the cardiovascular event was observed among patients with gout in the unadjusted model, although this effect was lost in the adjusted model (HR, 1.22; 95% CI, 0.99-1.51).

A shorter time to readmission for heart failure was observed in those with gout in the adjusted model (HR, 1.42; 95% CI, 1.02-1.97). Patients with gout had more days in the hospital for any cause during follow-up compared with those without gout (median 12.0 vs 7.0 days; P =.001). Patients with gout also had more days in the hospital for cardiovascular events compared with patients without gout (median, 7.0 vs 3.0 days; P <.001). Independent of gout diagnosis, higher baseline SU levels were associated with increased risk for death, readmission for a cardiovascular event, and readmission for heart failure.

Although post-ACS survival was similar in patients with and without gout, gout was associated with an increased risk for readmission for either a cardiovascular event or heart failure. In addition, gout was associated with longer hospital stays. These data may be useful to clinicians in managing post-ACS risks. Further research is necessary to determine whether lowering SU levels may improve post-ACS outcomes.

Reference

Stamp LK, Frampton C, Drake J, Doughty RN, Troughton RW, Richards AM. Associations of gout and baseline serum urate with cardiovascular outcomes: analysis of the Coronary Disease Cohort Study [published online June 4, 2019]. Arthritis Rheumatol. doi::10.1002/art.41007