Clinical Outcomes of Colchicine Use for Gout in HF Patients

A common comorbidity in heart failure (HF) patients is gout. Moreover, gout is associated with significantly higher rates of morbidity, mortality, and health care costs. Diuretics, often prescribed to patients with cardiac-related health problems, can lead to hyperuricemia (elevated uric acid levels in the blood) and increase the risk of gout flares. Gout in HF patients has been estimated to range from 16% to 40%. Colchicine, used to treat acute gout flares, has also recently demonstrated broader cardiovascular outcomes benefit in high‐risk patients; however, the literature of its impact in patients with acutely decompensated HF is somewhat sparce. A retrospective study published in Clinical Cardiology sought to rectify this and investigated clinical outcomes in patients treated for an acute HF exacerbation who received colchicine for acute gout flares.

The authors of the study examined adult patients with an acute HF exacerbation who received colchicine to treat an acute gout flare versus a control group without gout flare. Data and covariates were collected from patients’ medical records. The primary outcome measurement was in-hospital all-cause mortality, and secondary outcomes included hospital length of stay (LOS), 30-day readmission, and time to death. Additionally, researchers compared primary and secondary outcome measurements between patients with a prior history of gout and patients with an initial diagnosis of gout.

After exclusions, 237 patients were included in the colchicine group and 810 patients were included in the control group. Patients in the colchicine group were more likely to be younger, male, consume alcohol, and have a history of gout compared with the control group. Overall, the in-hospital all-cause mortality rate was 5.5%. When comparing cohorts, patients in the colchicine cohort had rates lower in-hospital all-cause mortality (2.1% vs 6.5%). The 30-day readmission rates were comparable between cohorts, and the mean LOS was significantly higher in the colchicine group (9.93 days) compared with the control group (7.96 days). No significant differences were observed in any primary or secondary outcome between patients with a new gout diagnosis compared with patients with a history of gout.

“The underlying mechanistic pathways that could explain the potential benefits of colchicine in the HF population are largely unknown but may be multifactorial,” the authors said. While the authors indicated the need for large multicenter retrospective and prospective randomized studies are still needed, they added, “if indeed our findings are validated, then consideration could be made for designing clinical trials that incorporate anti-inflammatory agents such as colchicine targeting this vulnerable phase of worsening HF.”