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

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MIKLÍKOVÁ Marie JARKOVSKÝ Jiří BENEŠOVÁ Klára VÍTOVEC Jiří LINHART Ales WIDIMSKY Petr ŠPINAROVÁ Lenka ZEMAN Kamil BELOHLAVEK Jan MALEK Filip FELŠŐCI Marián KETTNER Jiri OSTADAL Petr CIHALIK Cestmir ŠPÁC Jiří AL-HITI Hikmet FEDORCO Marian FOJT Richard KRUGER Andreas MALEK Josef MIKUSOVA Tereza MONHART Zdenek BOHACOVA Stanislava POHLUDKOVA Lidka ROHAC Filip VACLAVIK Jan VONDRAKOVA Dagmar VYSKOCILOVA Klaudia BAMBUCH Miroslav DOSTALOVA Gabriela HAVRANEK Stepan SVOBODOVÁ Ivana DUŠEK Ladislav ŠPINAR Jindřich MIKLIK Roman PAŘENICA Jiří

Rok publikování 2019
Druh Článek v odborném periodiku
Časopis / Zdroj Clinical Cardiology
Fakulta / Pracoviště MU

Lékařská fakulta

Citace
www http://dx.doi.org/10.1002/clc.23197
Doi http://dx.doi.org/10.1002/clc.23197
Klíčová slova acute heart failure; AHEAD; allopurinol
Popis 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 mu moL/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.
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