Pharmacologic Management of Gout in Patients with Cardiovascular Disease and Heart Failure

Mouradjian, Mallory T; Plazak, Michael E; Gale, Stormi E; Noel, Zachary R.; Watson, Kristin; Devabhakthuni, Sandeep

doi:10.1007/s40256-020-00400-6

Cited by 19 publications

(23 citation statements)

References 92 publications

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“…Approximately one in ten patients with HF has comorbid gout, which is an independent predictor of incident HF, HF hospitalization, and all‐cause mortality 41 . Hyperuricemia may worsen HF symptoms and impair vasodilation through stimulation of the RAAS and alteration in nitric oxide production 41 . Treatment consists of anti‐inflammatory therapies for the management of acute flares, followed by secondary prevention with chronic urate‐lowering therapy (ULT).…”

Section: Goutmentioning

confidence: 99%

“…Treatment of acute flares generally consists of colchicine, which appears safe in patients with HF 42,43 . Whereas several previously described studies revealed reduced CV events following colchicine administration, patients with HF were not directly assessed within these analyses 41 . Use may be limited in patients with renal dysfunction, as gastrointestinal adverse effects and myelosuppression may be more common.…”

Section: Goutmentioning

confidence: 99%

“…Intra‐articular therapy is preferred for monoarticular gout as systemic absorption is limited and adverse effects are infrequent 42 . Mineralocorticoid activity with systemic corticosteroids may be detrimental, as it results in sodium and free water retention, vasoconstriction, endothelial dysfunction, and myocardial fibrosis 41 . However, administration of up to 1 mg/kg/day (maximum 60 mg/day) prednisone in patients with chronic or acutely decompensated HF has been safely used.…”

Section: Goutmentioning

confidence: 99%

“…However, administration of up to 1 mg/kg/day (maximum 60 mg/day) prednisone in patients with chronic or acutely decompensated HF has been safely used. As such, if corticosteroids must be used to manage an acute flare of gout, a short course (3–5 days) of prednisone 30–40 mg is preferred to limit the risk of worsening HF 41 …”

Section: Goutmentioning

confidence: 99%

“…NSAIDs are contraindicated in patients with HF, due to increased vasoconstriction, trigger volume retention, and exacerbated diuretic resistance 8 . Although there is no evidence that canakinumab and anakinra worsen outcomes in patients with HF, use should be reserved for refractory symptoms given the high cost of these agents and their infectious risk 41,42 …”

Section: Goutmentioning

confidence: 99%

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Management of noncardiovascular comorbidities in patients with heart failure with reduced ejection fraction

et al. 2021

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Patients with heart failure with reduced ejection fraction often have one or more noncardiovascular comorbidities. The presence of concomitant disease states is associated with worse outcomes, including increased risk of mortality, decreased quality of life, and increased healthcare resource utilization. Additionally, the presence of heart failure with reduced ejection fraction complicates the management of these comorbidities, including varying safety and efficacy of therapies compared to those without heart failure. This article will review the literature on the pharmacologic management of common noncardiovascular comorbidities—including chronic obstructive pulmonary disease, depression, diabetes mellitus, gout, chronic kidney disease, and iron deficiency—in patients with heart failure with reduced ejection fraction, as well as provide recommendations for appropriate treatment selection in this population.

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Section: Goutmentioning

confidence: 99%

Section: Goutmentioning

confidence: 99%

Section: Goutmentioning

confidence: 99%

Section: Goutmentioning

confidence: 99%

Section: Goutmentioning

confidence: 99%

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Management of noncardiovascular comorbidities in patients with heart failure with reduced ejection fraction

et al. 2021

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The Chronic Systolic Heart Failure Patient: Presentation and Management

Bitar,

Aaronson

2023

Textbook of Transplantation and Mechanical Support for End‐Stage Heart and Lung Disease

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Adherence and Treat‐to‐Target Benchmarks in Older Adults With Gout Initiating Urate‐Lowering Therapy in Ontario, Canada: A Population‐Based Study

Kwok,

Kuriya,

Hawker

et al. 2024

Arthritis Care & Research

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ObjectivesWe sought to evaluate urate lowering therapy (ULT) adherence and treatment‐to‐target (T2T) serum uric acid (SUA) levels amongst older adults with gout starting ULT.MethodsWe performed a population‐based retrospective cohort study in Ontario, Canada in patients with gout aged ≥66 years newly dispensed ULT between 2010 and 2019. We defined successful T2T as patients having SUA levels <360 μmol/L (6 mg/dL) within 12‐months after ULT dispensation. We also assessed adherence to ULT. Multi‐level logistic regression clustered by ULT prescriber evaluated patient, physician and prescription factors associated with reaching target SUA levels.ResultsAmong 44,438 patients (mean (SD) age 76.0±7.3 years; 64.4% male), 30,057 (67.6%) patients had ≥1 SUA test completed. Overall, 52.3% patients reached SUA target within 12‐months, improving from 45.2% in 2010 to 61.2% in 2019 (p < 0.0001). ULT adherence was 55.3% overall and improved annually. Key factors associated with achieving T2T included febuxostat use (OR 11.40, 95% CI 5.10–25.43) (was only dispensed in 88 patients), ULT adherence (OR 5.17, 95% CI 4.89–5.47) allopurinol starting doses >50 mg (OR 2.53, 95% CI: 2.14–2.99), colchicine/oral corticosteroids co‐prescription (OR 1.24, 95% CI: 1.14–1.34) and ULT prescription from a rheumatologist.ConclusionsOnly 52.3% of patients achieved an optimal SUA level within 1 year of ULT initiation. ULT adherence was suboptimal though improving over time. ULT adherence and higher allopurinol starting doses had the strongest associations of achieving a target SUA level. This study highlights room for improvement in gout management and potential strategies to address care gaps.

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Pharmacologic Management of Gout in Patients with Cardiovascular Disease and Heart Failure

Cited by 19 publications

References 92 publications

Management of noncardiovascular comorbidities in patients with heart failure with reduced ejection fraction

Management of noncardiovascular comorbidities in patients with heart failure with reduced ejection fraction

The Chronic Systolic Heart Failure Patient: Presentation and Management

Adherence and Treat‐to‐Target Benchmarks in Older Adults With Gout Initiating Urate‐Lowering Therapy in Ontario, Canada: A Population‐Based Study

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