Heart Failure: Serum Uric Acid As Predictor Of Poor Outcome

Muthiah Vaduganathan, MD MPH Department of Medicine Massachusetts General Hospital Boston, Mass MedicalResearch.com Interview with:
Muthiah Vaduganathan, MD MPH
Department of Medicine
Massachusetts General Hospital
Boston, Mass


Medical Research: What are the main findings of the study?

Dr. Vaduganathan: Based on data from a large, multinational randomized controlled trial of patients hospitalized for heart failure and reduced ejection fraction (HFrEF), we conducted a retrospective analyses of the clinical profiles associated with baseline serum uric acid levels. Serum uric acid was commonly elevated in patients hospitalized for heart failure and reduced ejection fraction (mean ~9 mg/dL), especially in men and black patients. Higher uric acid levels were associated with lower systolic blood pressure and EF, higher natriuretic peptides, and more impaired renal function. After accounting for 24 known baseline covariates, serum uric acid was independently predictive of post-discharge mortality and rehospitalization in patients with relatively preserved renal function, but not in those with poor renal function.

Medical Research: What was most surprising about the results?

Dr. Vaduganathan: The prognostic utility of serum uric acid differs by baseline renal function, suggesting different biologic and pathophysiologic significance of serum uric acid among those with and without significant renal dysfunction.

Medical Research: What should clinicians and patients take away from your report?

Dr. Vaduganathan: A single baseline measurement of serum uric acid can help identify patients at high risk of poor post-discharge prognosis after hospitalization for heart failure and reduced ejection fraction, even beyond traditional markers and known predictors of adverse events.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Vaduganathan: We eagerly await the results of the recently completed EXACT-HF (Xanthine Oxidase Inhibition for Hyperuricemic Heart Failure Patients; NCT00987415) trial, which is a multicenter randomized, 24-week trial of allopurinol in hyperuricemic (sUA ≥9.5 mg/dL) chronic heart failure and reduced ejection fraction.

Citation:

Relation of Serum Uric Acid Levels and Outcomes among Patients Hospitalized for Worsening Heart Failure with Reduced Ejection Fraction (From the EVEREST Trial)