Prognostic impact of hyperuricemia in chronic heart failure

Type of funding sources: None.

Today there is numerous evidence of the importance of hyperuricemia in the progression of chronic heart failure (HF).

To study the impact of uricemia in patients (pts) with HF with reduced ejection fraction (HFrEF) followed in a Heart Failure Clinic (HFC).

Retrospective study of consecutive patients admitted in heart failure clinic of a cardiology center from February/2018 to December/2020, with an initial left ventricular ejection fraction (LVEF) < 50%; Primary outcomes were a composite of death, HF hospitalizations or emergency department admission.

A total of 269 patients were selected, (mean age 71.0 ± 11.1 years; 69% males; ~40% ischemic etiology) of which 31,9% had uric acid (UA) ≥ 7 mg/dl in the first measure. These patients had more ischemic heart disease (44% vs 31,4%, p=0,048) and were mostly man (81,8 vs 63,80%, p= 0,004), but had less arterial hypertension (61,4 vs 72,8%; p=0.41). Both groups had the same incidence of diabetes mellitus (35,1 VS 34,1, p=0,868), active or previous tabagism (11,7 VS 7, p=0,456, 24,7 vs 24,9 p=0,456), dyslipidemia ( 53,2 vs 58, p=0,456), functional NYHA class ≥ 2 (93,8 VS 94,1, p=0,207) and use of allopurinol (68,8 vs 75,7%, p=0,252).

During a median follow-up of 16 months (IQR 15–51), 65 patients (24,2%) had the primary outcome.

After adjusting for ischemic heart disease, sex and use of allopurinol, uric acid levels superior to 7 mg /dl on admission is a predictor of poor outcomes in HFrER (HR 1.83, 95% CI: 1,89-3,08; p<0,023).

Patients with uric acid levels superior or equal to 7 mg/dl on admission had a higher risk of death, HF hospitalizations or emergency department admission during follow-up in HFC. UA might be considered a HF prognostic marker.