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

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.

Uric Acid and Cardiovascular Disease: An Update From Molecular Mechanism to Clinical Perspective

“…UA may play an important role in HF. A large number of studies ( Vaduganathan et al, 2014 ; Palazzuoli et al, 2017 ; Pavlusova et al, 2019 ) and meta-analyses ( Huang et al, 2014 ) have evaluated the relationship between sUA and the risk and adverse outcome of HF. The results indicate that the increase of sUA may be an important risk factor for the incidence and prognosis of HF ( Huang et al, 2014 ; Vaduganathan et al, 2014 ; Palazzuoli et al, 2017 ; Pavlusova et al, 2019 ).…”

Uric acid is a biomarker for heart failure, but not therapeutic target: result from a comprehensive meta‐analysis

“…Follow‐up time range from 0.5 to 4.8 years. Two studies were from the USA, 17 , 21 two studies were from the Czech Republic, 16 , 46 one study was from Japan, 43 two studies were from the UK, 15 , 47 and the others were from China, 19 Canada, 48 Israel, 14 and Italy, 49 respectively. Additionally, there were three international multicentre studies.…”

Role of hyperuricemia in cardiovascular disease and its treatment options: A review article

“…It appears that treatment with low doses of Allopurinol does not enhance the prognosis of HF patients in acute HF, and even patients with SUA ≥500 μmoL/L treated with a low dose of allopurinol had a poorer prognosis than the untreated group in acute HF (19).…”