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Clin Cardiol. 2019 May 22. doi: 10.1002/clc.23197. [Epub ahead of print]

Hyperuricemia treatment in acute heart failure patients does not improve their long-term prognosis: A propensity score matched analysis from the AHEAD registry.

Author information

1
Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.
2
Faculty of Medicine, Masaryk University, Brno, Czech Republic.
3
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
4
First Department of Internal Medicine, Cardiology and Angiology, St Anne's University Hospital Brno, Brno, Czech Republic.
5
Second Department of Internal Medicine, Department of Cardiology and Angiology, First Faculty of Medicine of the Charles University, Prague, and General University Hospital in Prague, Czech Republic.
6
University Hospital Kralovske Vinohrady and the Third Faculty of Medicine of the Charles University, Prague, Czech Republic.
7
Department of Internal Medicine, Hospital Frydek-Mistek, Frydek-Mistek, Czech Republic.
8
Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic.
9
Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic.
10
Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic.
11
Second Department of Internal Medicine, St Anne's University Hospital Brno, Brno, Czech Republic.
12
Department of Internal Medicine, Hospital Havlickuv Brod, Havlickuv Brod, Czech Republic.
13
Department of Internal Medicine, Hospital Znojmo, Znojmo, Czech Republic.
14
Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic.
15
Department of Internal Medicine, Military Hospital Brno, Brno, Czech Republic.

Abstract

BACKGROUND:

Hyperuricemia is associated with a poorer prognosis in heart failure (HF) patients. Benefits of hyperuricemia treatment with allopurinol have not yet been confirmed in clinical practice. The aim of our work was to assess the benefit of allopurinol treatment in a large cohort of HF patients.

METHODS:

The prospective acute heart failure registry (AHEAD) was used to select 3160 hospitalized patients with a known level of uric acid (UA) who were discharged in a stable condition. Hyperuricemia was defined as UA ≥500 μmoL/L and/or allopurinol treatment at admission. The patients were classified into three groups: without hyperuricemia, with treated hyperuricemia, and with untreated hyperuricemia at discharge. Two- and five-year all-cause mortality were defined as endpoints. Patients without hyperuricemia, unlike those with hyperuricemia, had a higher left ventricular ejection fraction, a better renal function, and higher hemoglobin levels, had less frequently diabetes mellitus and atrial fibrillation, and showed better tolerance to treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and/or beta-blockers.

RESULTS:

In a primary analysis, the patients without hyperuricemia had the highest survival rate. After using the propensity score to set up comparable groups, the patients without hyperuricemia had a similar 5-year survival rate as those with untreated hyperuricemia (42.0% vs 39.7%, P = 0.362) whereas those with treated hyperuricemia had a poorer prognosis (32.4% survival rate, P = 0.006 vs non-hyperuricemia group and P = 0.073 vs untreated group).

CONCLUSION:

Hyperuricemia was associated with an unfavorable cardiovascular risk profile in HF patients. Treatment with low doses of allopurinol did not improve the prognosis of HF patients.

KEYWORDS:

AHEAD; acute heart failure; allopurinol

PMID:
31119751
DOI:
10.1002/clc.23197
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