Research published in the Archives of Internal Medicine has evaluated whether gout and allopurinol are associated with heart failure (HF) outcomes.

The time-matched, nested case-control analysis involved the use of a retrospective cohort of patients with HF (identified using a healthcare database in Canada) who were 66 years. The primary outcome measure was a composite measure of HF readmission and all-cause mortality. The secondary outcome measure was all-cause mortality.

The following results were reported:
• Of 25,090 patients in this cohort, 14,327 experienced the primary outcome. Of the 14,327 events for the composite outcome measure, 7581 (52.9%) were for an HF readmission and 6746 (47.1%) were for mortality.
• Both a remote history of gout and an acute episode of gout (within 60 days of the event date) were associated with an increased risk of HF readmission or death (adjusted rate ratio, 1.63; 95% confidence interval, 1.48-1.80; P < 0.001 and 2.06; 1.39-3.06; P < 0.001, respectively).
• Continuous allopurinol use (>30 days of continuous use) was not associated with the primary outcome among the overall population with HF (adjusted rate ratio, 1.02; 95% confidence interval, 0.95-1.10; P = 0.55) but was associated with reduced HF readmissions or death (0.69; 0.60-0.79; P < 0.001) and all-cause mortality (0.74; 0.61-0.90; P < 0.001) among patients with a history of gout.

The researchers concluded that these results indicate that patients with HF and a recent or remote history of gout represent a high-risk subgroup, and in these high-risk patients allopurinol use appears to be associated with important reductions in adverse outcomes.