scholarly journals THU0444 INCIDENCE OF ACUTE GOUT FLARE IN PATIENTS INITIATED ON INTRAVENOUS BUMETANIDE FOR ACUTE CONGESTIVE HEART FAILURE EXACERBATION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 459.1-459
Author(s):  
S. Jeong ◽  
I. Tan
Keyword(s):  
Heart Failure ◽  
Uric Acid ◽  
Retrospective Cohort ◽  
P Value ◽  
Acute Gout ◽  
Readmission Rates ◽  
History Of ◽  
Heart Failure Exacerbation ◽  
Gout Flare ◽  
Gout Flares

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 death1. 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 failure2.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 1Patient SelectionPatients 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

scholarly journals Serum uric acid control for prevention of gout flare in patients with asymptomatic hyperuricaemia: a retrospective cohort study of health insurance claims and medical check-up data in Japan

2021 ◽  
pp. annrheumdis-2021-220439
Author(s):  
Ruriko Koto ◽  
Akihiro Nakajima ◽  
Hideki Horiuchi ◽  
Hisashi Yamanaka
Keyword(s):  
Uric Acid ◽  
Cohort Study ◽  
Health Insurance ◽  
Serum Uric Acid ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Disease Status ◽  
Insurance Claims ◽  
Health Insurance Claims ◽  
Gout Flare

ObjectivesIn patients with gout, treating to target serum uric acid levels (sUA) of ≤6.0 mg/dL is universally recommended to prevent gout flare. However, there is no consensus on asymptomatic hyperuricaemia. Using Japanese health insurance claims data, we explored potential benefits of sUA control for preventing gout flare in subjects with asymptomatic hyperuricaemia.MethodsThis retrospective cohort study analysed the JMDC Claims Database from April 2012 through June 2019. Subjects with sUA ≥8.0 mg/dL were identified, and disease status (prescriptions for urate-lowering therapy (ULT), occurrence of gout flare, sUA) was investigated for 1 year. Time to first onset and incidence rate of gout flare were determined by disease status subgroups for 2 years or more. The relationship between gout flare and sUA control was assessed using multivariable analysis.ResultsThe analysis population was 19 261 subjects who met eligibility criteria. We found fewer occurrences of gout flare, for both gout and asymptomatic hyperuricaemia, in patients who achieved sUA ≤6.0 mg/dL with ULT than in patients whose sUA remained >6.0 mg/dL or who were not receiving ULT. In particular, analysis by a Cox proportional-hazard model for time to first gout flare indicated that the HR was lowest, at 0.45 (95% CI 0.27 to 0.76), in subjects with asymptomatic hyperuricaemia on ULT (5.0<sUA ≤ 6.0 mg/dL), compared with untreated subjects (sUA ≥8.0 mg/dL).ConclusionsOccurrences of gout flare were reduced by controlling sUA at ≤6.0 mg/dL in subjects with asymptomatic hyperuricaemia as well as in those with gout.Trial registration numberUMIN000039985.

Abstract P83: Predictors of Length of Stay for HF Patients: Results from Get With the Guidelines

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
David J Whellan ◽  
Xin Zhao ◽  
Adrian F Hernandez ◽  
Eric D Peterson ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Length Of Stay ◽  
Vital Signs ◽  
P Value ◽  
Chi Square ◽  
Unit Increase ◽  
History Of ◽  
Multivariable Regression ◽  
Get With The Guidelines

Background: Heart failure (HF) admissions are frequent and result in significant expenditures. Identifying predictors of increased length of stay (LOS), particularly above the median LOS, may help providers set expectations for patients and target resources effectively. Methods: We analyzed HF admissions (n= 70,094) from January 2005 through April 2007 from 246 hospitals in the AHA's Get With The Guidelines-HF program. In a subset with BNP (n=44,535), baseline characteristics, admission vital signs and selected labs (BNP, creatinine, BUN, hemoglobin, and sodium) were included in a multivariable regression analysis to determine factors associated with LOS ≥4 days. Results: Patients were median age of 72, 45% female, 53% had ischemic etiology, and median LVEF was 35%. Median LOS was 4 days (25 th ,75 th 2,6). The most significant predictors of LOS ≥ 4 days were a higher admission BUN, higher heart rate, and lower SBP (Table 1). Age, insurance, race, creatinine, and LVEF were not. Conclusion: Upon admission for HF, certain vital signs, comorbidites, and laboratory values are associated with an increased likelihood of a LOS ≥ 4 days. These observations may be of value in the implementation of interventions aimed at reducing LOS and improving quality of care in HF. Variables Associated With Hospital LOS >/= 4 Days Variable Chi-Square OR Lower (95% CI) Upper (95% CI) P-value Admissioun BUN (/1 unit increase) 221.8 1.01 1.01 1.01 <.001 Admission SBP (/ 10-unit increase) 129.6 0.96 0.95 0.96 <.001 Heart Rate (/ 10-unit increase) 122.4 1.07 1.06 1.09 <.001 History of COPD/Asthma 45.8 1.19 1.13 1.25 <.001 Admission BNP (per 100-unit increase) 37.6 1.01 1.00 1.01 <.001 Female vs. Male 29.7 1.12 1.08 1.17 <.001 History of renal insufficiency 27.4 1.17 1.10 1.24 <.001 History of heart failure 18.0 0.89 0.85 0.94 <.001 Region: (MW vs. NE)
 (S vs NE)
 (W vs. NE) 17.3 0.71
 0.91
 0.71 0.60
 .077
 0.56 0.85
 1.08
 0.88 <.001

scholarly journals Correction to: Anakinra for colchicine-intolerant/colchicine-resistant acute gout flare precipitated by decompensated heart failure

2020 ◽  
Author(s):  
Muhammad Hamza Saad Shaukat ◽  
Muhammad Asim Shabbir ◽  
Sukhraj Singh ◽  
Mikhail Torosoff ◽  
Ruben Peredo-Wende
Keyword(s):  
Heart Failure ◽  
Decompensated Heart Failure ◽  
Acute Gout ◽  
Gout Flare

scholarly journals Crystal Arthropathy in the Setting of Total Knee Arthroplasty

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Joseph C. Brinkman ◽  
Kade S. McQuivey ◽  
Justin L. Makovicka ◽  
Joshua S. Bingham
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Ground Level ◽  
Fracture Dislocation ◽  
Acute Gout ◽  
Orthopedic Surgeons ◽  
History Of ◽  
Total Knee ◽  
Gout Flare

We present a case of an 82-year-old female with a history of right total knee arthroplasty 11 years prior. She was admitted after a ground-level fall and developed progressive pain and swelling of her right knee. She had no history of complications with her total knee replacement. Radiographs of the knee and hip were negative for acute fracture, dislocation, or hardware malalignment. Knee aspiration was performed and revealed inflammatory exudate, synovial fluid consistent with crystal arthropathy, and no bacterial growth. She was diagnosed with an acute gout flare, and her symptoms significantly improved with steroids and anti-inflammatory treatment. Orthopedic surgeons should be aware of the potential for crystal arthropathy in the setting of total joint arthroplasty and evaluate for crystals before treating a presumed periprosthetic joint infection.

scholarly journals IL-1 inhibitor anakinra is an effective alternative to standard treatments for reducing pain due to acute gout flare

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Cheryl Craig
Keyword(s):  
Standard Treatment ◽  
Clinical Decision ◽  
Effective Alternative ◽  
Acute Gout ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Active Comparator ◽  
Gout Flare ◽  
Gout Flares

A clinical decision report appraising Janssen CA, Voshaar MAHO, Vonkeman HE, et al. Anakinra for the treatment of acute gout flares: a randomized, double-blind, placebo-controlled, active-comparator, non-inferiority trial. Rheumatology. 2019;58(8):1344-1352. https://doi.org/10.1093/rheumatology/key402 for a patient with an acute gouty attack refractory to standard treatment.

scholarly journals Medical Image of the Month: Superior Vena Cava Syndrome

2020 ◽  
pp. 136-137
Author(s):  
Matthew Borchart ◽  
◽  
Daniel Yu ◽  
Indrajit Nandi
Keyword(s):  
Heart Failure ◽  
Medical Image ◽  
Superior Vena Cava Syndrome ◽  
Diastolic Heart Failure ◽  
Superior Vena ◽  
Vena Cava ◽  
Lymphocytic Leukemia ◽  
History Of ◽  
Vena Cava Syndrome ◽  
Heart Failure Exacerbation

No abstract available. Article truncated after 150 words. History A 74-year- old man with a history of diastolic heart failure, chronic kidney disease (CKD), and chronic lymphocytic leukemia (CLL) presented with a complaint of dyspnea. He has had several hospitalizations in the last year for heart failure exacerbation and his home bumetanide was recently increased from twice to three times daily due to persistently increasing weight. His CLL was diagnosed two years prior and treatment was stopped three months ago due to side effects. In the emergency department he reported three weeks of worsening dyspnea especially when lying flat, as well as increased swelling in his legs, abdomen, arms, and face. His weight was up to 277lbs from 238lbs the month before. His diuretics were transitioned to IV, but over the next few days he remained clinically volume overloaded. A noncontrast chest CT was obtained to help evaluate his ongoing respiratory distress (Figure 1). It demonstrated innumerable lymph …

scholarly journals Infantile Nephropathic Cystinosis in Sulaimani Pediatric Teaching Hospital: A Retrospective Cohort Study

2018 ◽  
Vol 3 (1) ◽  
pp. 5-8
Author(s):  
Hunar Jamal Hussein ◽  
Khalid Hama Salih ◽  
Adnan Mohammed Hasan
Keyword(s):  
Cohort Study ◽  
End Stage Renal Disease ◽  
Retrospective Cohort ◽  
Positive Family History ◽  
The Other ◽  
P Value ◽  
History Of ◽  
Infantile Cystinosis ◽  
Stage Renal Disease ◽  
End Stage

Cystinosis is a rare metabolic autosomal recessive disorder which characterized by intralysosomal accumulation of cystine. There are three forms; infantile nephropathic is the commonest forms. to evaluate clinical presentations and outcome of infantile cystinosis. A retrospective cohort study conducted in Sulaimani Pediatric Teaching Hospital on 25 patients with infantile cystinosis during May 1, 2014, to June 1, 2017. This study has depended on clinical symptoms and signs, and corneal crystallization for the diagnosis of cystinosis. Gender of the patients was 13 (52%) females and 12 (48%) males. The ages were ranged between (1-12 years) with a mean age of (6.25 years). Eight (32%) patients were from Sulaimani city, but the other 17 (68%) patients were from outside of Sulaimani. Moreover, a 17 (68%) of them were Arabic and the other eight (32%) were Kurdish ethnic groups. The study showed a 20 (80%) positive consanguinity with 19 (76%) positive family history of infantile cystinosis. Additionally, the age of first presentations was between (0.25-2 years) with a mean of (0.8 years). Clinical features included a 100% for polyuria, polydipsia, and failure to thrive. Furthermore, 10 (40%) presented with constipation, 23 (92%) photophobia and 5 (20%) blond hair. Complications included 24 (96%) rickets, 14 (56%) renal insufficiency, 5 (20%) hypothyroidism, 4 (16%) genu valgum, 3 (12%) growth hormone deficiency, and 3 (12%) developed end-stage renal disease. Subsequently, two patients died (8%) due to end-stage renal disease. Finally, there was a statistically significant relationship between both renal insufficiency (P-value = 0.042) and hypothyroidism (P-value < 0.001) with Kurdish ethnicity. Conclusion: Incidence of cystinosis was high among consanguineous parents and those patients who had a positive family history of cystinosis. Furthermore, the delay in diagnosis was due to atypical presentations and unavailability of specific investigations.

scholarly journals The Impact of Discharged Loop Diuretic Dose to Home Dose on Hospital Readmissions in Patients with Acute Decompensated Heart Failure: A Retrospective Cohort Study

2020 ◽  
Vol 23 (4) ◽  
pp. E470-E474 ◽  
Author(s):  
Mohannad Alshibani ◽  
Samah Alshehri ◽  
Wejdan Alyazidi ◽  
Asmaa Alnomani ◽  
Ziyad Almatruk ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
Retrospective Cohort ◽  
Readmission Rate ◽  
Dose Group ◽  
Loop Diuretic ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Readmission Rates ◽  
Daily Discharge

Background: Acute decompensated heart failure (ADHF) is associated with a high rate of hospital readmission. The aim of this study is to examine the effect of the discharge diuretic dose compared with the home diuretic dose on hospital readmission in patients with ADHF. Methods: A single center retrospective cohort study included patients with a confirmed diagnosis of ADHF with an ejection fraction of less than 40%. The sample was divided in two groups. The first group received a total daily discharge diuretic dose that was greater than the home dose; the second group received a daily discharge diuretic that was equal to or less than the home dose. The primary outcome was all-cause 30-day readmission rate. The secondary outcomes were all-cause 60-day and 90-day readmission rates. Results: A total of 206 patients met inclusion criteria; 117 patients received a higher loop diuretic dose at discharge, while 89 were discharged with a loop diuretic that was equal to or less than the home dose. Patients in the increased-dose group had an all-cause 30-day readmission rate of 20.5% compared with 37.1% of patients with equal or reduced-dose group; P = .007. Additionally, there were lower readmission rates in 60 and 90 days between the increased and equal or reduced groups (33.3% versus 52.8%, P < .017, and 41.0% versus 62.9%, P < .003, respectively. Conclusions: Among patients admitted to hospital with ADHF and reduced ejection fraction, a discharge loop diuretic dose higher than the home dose was associated with decreased all-cause 30-day, 60-day, and 90-day readmission rates.

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