Objectives: Gout is an independent cardiovascular (CV) risk factor with significant morbidity and mortality. We aimed to estimate the prevalence of gout, characteristics and management in a hospitalized population for CV disease, a topic that remains to be defined. Methods: An observational, descriptive, cross-sectional study was carried out in patients admitted for CV events in the Cardiology, Neurology, and Vascular Surgery units of a tertiary center. Patients were selected following a non-consecutive, systematic sampling. Data about CV disease and gout were obtained from face-to-face interviews and patients' records. Gout diagnosis was established using the 2015 ACR/EULAR clinical classification criteria. The registration rate of gout was assessed by auditing patients' records and hospital discharge reports of CV events from the units of interest in the previous 2 years. To predict the presence of gout, multivariate logistic regression models were built to study the possible explanatory variables. Results: Two hundred and sixty six participants were recruited, predominantly males (69.9%) and Caucasians (96.6%) with a mean age of 68 years. Gout was identified in 40 individuals; thus, the prevalence was 15.0% (95% CI 10.9-19.2%). In 35% of cases, the diagnosis was absent from patients' records. Gout was found in 1.4-2.6% of hospital discharge reports of CV events, also indicating under-registration. The disease was long-standing, but with low reported rates of flares, involved joints, and tophi. At admission, only half of the gout patients were on urate-lowering therapy, being 38.5% of them on serum urate <6 mg/dl. The only independent predictor of gout was the existence of previous hyperuricemia (median serum urate in previous 5 years ≥7 mg/dl), with an odds ratio of 2.9 (95% CI 1.2-7.1); if hyperuricemia is not included in the model, the only independent predictor was chronic kidney disease (odds ratio 3.0; 95% CI 1.4-6.6). Conclusion: Gout is highly prevalent among patients admitted for CV events, with significant lack of awareness and suboptimal management, despite being a well-established independent CV risk factor.

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Objective: Gout is prevalent in people with cardiovascular disease, although up to a third of the cases remain unregistered. We aimed to assess whether active gout screening in inpatients with cardiovascular events helps identify patients at higher risk of mortality after discharge.Methods: This study included patients admitted for cardiovascular events. Gout was established by records review and clinical interview. After discharge, electronic medical records were reviewed for mortality and cause of death. The association between gout and subsequent mortality was tested using Cox regression models.Results: Of 266 recruited patients, 17 were lost to follow-up, leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5%) were classified as having gout; 13 of these (36.1%) were identified through the interview. Mean follow-up was 19.9 (SD, 8.6) months. Gout significantly increased the risk of all-cause mortality in the overall sample (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.13-3.58) and in the subgroup with a prior diagnosis of gout (HR, 2.89; 95% CI, 1.54-5.41). The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI, 1.01-3.41). Patients with gout carried an increased risk of both cardiovascular and noncardiovascular deaths; age and chronic kidney disease were mortality predictors within the gout population. Conclusion:Gout was an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed the detection of a larger population at high risk of mortality and could help tailor patient management to minimize the cardiovascular impact.

BackgroundGout is an independent risk factor for cardiovascular diseases (CVDs), where the urate crystal-led inflammatory state likely has a key role. Crystal dissolution may carry with cardiovascular benefits, so optimal management of gout patients is essential, especially in high-risk individuals, such as those hospitalised for CVDs. Although the prevalence of gout in Western country adults is about 2-4% [1], the rate and characteristics in inpatients with CVDs remains to be defined.ObjectivesTo determine the prevalence of gout, characteristics and management in a hospitalised population for CVDs.MethodsObservational, descriptive, cross-sectional study. Patients admitted for CVDs in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre were recruited following a non-consecutive, systematic sampling up to reaching the estimated minimum sample size. A face-to-face interview and a review of electronic health records were performed, in order to collect clinical, laboratory and management data regarding CVD and gout. Gout diagnosis was established in the interview using ACR/EULAR 2015 criteria. In addition, prior clinical or crystal-proven diagnoses at records were also registered. 95% confidence intervals (95%CI) were calculated for primary variable (gout prevalence), and comparisons were performed by Student’s t, chi-squared and Fisher’s exact tests.Results299 patients were interviewed, 33 were excluded, and the final study sample was 266 participants. They were predominantly males (69.9%) and Caucasians (96.6%) with a mean age of 68 years (SD±12). The CVDs leading to admission were acute coronary syndrome (18.8%; n=50), heart failure (13.2%; n=35), stroke or transient ischemic attack (20.7%; n=55) and peripheral artery disease (47.4%; n=126).Gout was identified in 40 individuals (prevalence 15.0%; 95%CI 10.9-19.2). Prior gout diagnosis in records was found in only two-thirds of them, mostly clinical (Table).Patients with gout were older (72±9 vs 68±13 years, p=0.026) and showed higher rates of chronic kidney disease (55.0% vs 23.0%, p<0.001) and use of diuretics (55.0% vs 38.5%, p=0.05), with no differences in other variables.The disease was long-standing though low numbers of flares and involved joints were referred (Table). Tophi were seen in about 8%. The serum urate levels were not properly controlled, both at the time of the CVD and as a median of the previous five years, and only one-third of the patients were on target (<6 mg/dl). Despite 70% of patients having been treated with urate-lowering agents at some point, at admission only half remained treated (38.5% of them were on target). Nearly a quarter of patients used prophylactic colchicine.Abstract AB0865 Table 1 Clinical & management of gout in inpatients for CVDs.Gout (n=40)Prior diagnosis at records-No-Clinical diagnosis-Proven by crystals14 (35.0)20 (50.0)6 (15.0)Serum urate levels (mg/dl) at admission, mean (SD)7.1 (±2.6)Median serum urate levels in the previous 5 years (mg/dl), mean (SD) 6.8 (±1.6) Current serum urate <6 mg/dl8 ...

Background:We have recently revealed by active screening that about a third of gout cases in the cardiovascular population is not registered in records [1], highlighting the value of field studies.Objectives:To assess whether gout screening in patients hospitalized for cardiovascular events may also help identify patients at higher risk of mortality after discharge.Methods:A retrospective cohort field study, carried out in 266 patients admitted for cardiovascular events in the Cardiology, Neurology and Vascular Surgery units of a tertiary centre in Spain. The presence of gout was established by records review and face-to-face interview, according to the 2015 ACR/EULAR criteria. The occurrence of mortality during follow-up and its causes were obtained from electronic medical records. The association between gout and subsequent mortality was tested using Cox regression models. Whether covariates affect the gout-associated mortality was also studied.Results:Of 266 patients recruited at baseline, 17 were excluded due to loss to follow-up (>6mo), leaving a final sample of 249 patients (93.6%). Thirty-six cases (14.5% of the sample) were classified as having gout: twenty-three (63.9%) had a previously registered diagnosis, while 13 (36.1%) had not and was established by the interview.After discharge, the mean follow-up was 19.9 months (SD ±8.6), with a mortality incidence of 21.6 deaths per 100 patient-years, 34.2% by cardiovascular causes.Gout significantly increased the risk of subsequent all-cause mortality, with a hazard ratio (HR) of 2.01 (95%CI 1.13 to 3.58). When the analysis was restricted to gout patients with registered diagnosis, the association remained significant (HR 2.89; 95%CI 1.54 to 5.41).The adjusted HR for all-cause mortality associated with gout was 1.86 (95% CI 1.01-3.40). Regarding the causes of death, both cardiovascular and non-cardiovascular were numerically increased.Secondary variables rising the mortality risk in those with gout were age (HR 1.07; 1.01 to 1.13) and coexistent renal disease (HR 4.70; 1.31 to 16.84), while gender, gout characteristics and traditional risk factors showed no impact.Conclusion:Gout was confirmed an independent predictor of subsequent all-cause mortality in patients admitted for cardiovascular events. Active screening for gout allowed identifying a larger population at high mortality risk, which may help tailor optimal management to minimize the cardiovascular impact.References:[1]Calabuig I, et al. Front Med (Lausanne). 2020 Sep 29;7:560.Disclosure of Interests:Silvia Ruiz-Simón: None declared, Irene Calabuig: None declared, Miguel Gomez-Garberi: None declared, Mariano Andrés Speakers bureau: Grunenthal, Menarini, Consultant of: Grunenthal, Grant/research support from: Grunenthal