Relationship between serum uric acid and prognosis in different subtypes of elderly patients with heart failure

Background Elevated serum uric acid (sUA) levels have been associated with poor outcome in patients with heart failure. Uric acid is associated with inflammation and microvascular dysfunction, which may differentially affect left ventricular ejection fraction phenotypes.

Objective To identify the role of sUA across ejection fraction phenotypes in hospitalized elderly patients with chronic heart failure.

Methods The medical records of elderly patients who were diagnosed with chronic heart failure were analyzed. All the patients received sUA testing within the first 24h following admission, and were divided into three groups according to the sUA level: low sUA group (sUA<304.2 μmol/L, n=451), medium sUA group (sUA 304.2-387.2 μmol/L, n=453), and high sUA group (sUA>387.2 μmol/L, n=451). The endpoint was cardiovascular death, and Cox regression models were used to analyze the association between sUA level and risk of cardiovascular death.

Results Totally 1355 patients were included and the median follow-up period was 18 months. A total of 92 cardiovascular deaths (6.8%) occurred in the whole cohort. There were 47 (13.9%), 24 (6.1%), and 21 (3.4%) cardiovascular deaths in heart failure with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction (HFmrEF), and heart failure with preserved ejection fraction, respectively. Compared with the low sUA group, the high sUA group had higher risk of cardiovascular deaths (adjusted HR=2.141, 95% CI: 1.199-3.824, P=0.01). In the subgroup analysis, among patients with HFrEF, the risk of adverse events was higher in the high sUA group compared to the low sUA group (HR=4.151, 95% CI: 1.866-9.234, P<0.001). Among patients with HFmrEF, the risk of cardiovascular death events was also higher in the high sUA group compared to the low sUA group (HR=4.724, 95% CI: 1.664-13.414, P=0.004).

Conclusion In hospitalized elderly patients with chronic heart failure, sUA is an independent predictor of adverse outcome, which can be observed in HFrEF and HFmrEF patients.