THU0444 INCIDENCE OF ACUTE GOUT FLARE IN PATIENTS INITIATED ON INTRAVENOUS BUMETANIDE FOR ACUTE CONGESTIVE HEART FAILURE EXACERBATION
Authors: S. Jeong, I. Tan
Journal: Annals of the Rheumatic Diseases (2020)

Background: Heart failure is a prevalent and ever-increasing public health concern associated with significant morbidity, mortality, and financial burden. Therefore, identifying any factors that worsen the outcome of patients with heart failure is crucial to the nation’s medical and financial health. One of the major comorbidities associated with heart failure is gout. Gout is a clinical syndrome of joint inflammation resulting from the deposition of monosodium urate crystals, causing painful and swollen arthritis. Acute gout flares in the context of acute heart failure (AHF) exacerbations result in longer lengths of stay and form an independent risk factor for increased readmissions or death 1 . The use of loop diuretics in treating patients with AHF exacerbations may cause new onset of gouty arthritis or recurrence of established gout by increasing serum uric acid levels. Uric acid alone is implicated as an independent predictor of mortality in patients with chronic heart failure 2 . Objectives: In this study, we aim to better characterize the incidence of acute gout flares in patients being treated with intravenous bumetanide for AHF exacerbations. Methods: This single-center retrospective cohort study included adult patients within an urban tertiary-care center hospital between 5 August 2016 and 30 June 2018. Chart review was performed to identify 130 patients who were hospitalized for AHF exacerbations, received intravenous (IV) bumetanide, and developed an acute gout flare for a total of 176 cases (Figure 1). Figure 1 Patient Selection Patients were identified as having an acute gout flare if the primary treating physician(s) documented a clinical picture congruous with acute gout (e.g., onset of a painful, swollen, or erythematous joint) and administered conventional treatment for acute gout including non-steroidal anti-inflammatory agents (NSAIDs), steroids, colchicine, urate-lowering therapies, and/or intra-articular joint injection with symptomatic improvement. Results: The annualized incidence of acute gout while receiving IV bumetanide for a heart failure exacerbation is 7.17%. There was no statistical difference in age, gender, race, or BMI among patients who developed acute gout compared with those who did not develop acute gout while receiving IV bumetanide. An acute gout flare that occurred during treatment of AHF with IV bumetanide increased hospital length of stay (LOS) by 3 days (mean LOS 15.2 days in those who had acute gout, mean LOS 11.6 days in those who did not [p-value 0.277]). Patients who received allopurinol during their hospitalization for AHF exacerbation had lower 30-day readmission rates for any cause (p-value 0.017, Table 4). There was no reduction in the 30-day readmission rate in patients who received colchicine without allopurinol during their hospitalization for AHF exacerbation. Those with a history of gout had higher readmission rates than those without a history of gout (p-value 0.007). Conclusion: Gout is known to be a weighty contributor to patients’ morbidity and mortality in heart failure, and the occurrence of acute gout flare in AHF exacerbations may be precipitated by the use of loop diuretics. We show that the use of IV bumetanide in patients hospitalized for AHF exacerbations is associated with a 7.17% yearly incidence of acute gout flares. Furthermore, patients with a history of gout were found to have higher readmission rates, and those who received allopurinol during their hospitalization had lower readmission rates. References: [1]Thanassoulis G, Brophy JM, Richard H, Pilote L. Gout, Allopurinol Use, and Heart Failure Outcomes. Arch Intern Med . 2019;170(15):1358-1364. [2]Struthers AD, Donnan PT, Lindsay P, Mcnaughton D, Broomhall J, Macdonald TM. Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study. Heart . 2002;87(3):229-234. Disclosure of Interests: : None declared