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Published on: June 11, 2012
Management of Gout in a Hospital Setting: A Lost Opportunity
Sarah Wright1,2, Peter T Chapman1,2, Christopher Frampton1,2
1From the Department of Rheumatology, Immunology and Allergy, Christchurch Hospital; Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand.
Insights
Hospital admissions for gout flares are common, but management of acute attacks and long-term urate lowering often falls short of international guidelines, missing opportunities for better patient outcomes.
Area of Science:
- Rheumatology
- Internal Medicine
- Clinical Audit
Background:
- Gout management is frequently suboptimal, leading to poor patient outcomes.
- Acute gout flares and inadequate urate-lowering therapy contribute to hospital admissions.
Purpose of the Study:
- To determine the proportion of patients admitted to Christchurch Hospital for gout flares.
- To assess adherence to international recommendations for acute gout flare and urate-lowering management.
Main Methods:
- Retrospective audit of hospital admissions with gout as a primary or secondary diagnosis.
- Data collection on demographics, comorbidities, medications, acute gout treatment, and urate levels.
- Analysis of urate-lowering therapy initiation and recommendations.
Main Results:
- 235 admissions for gout were identified, with gout as the primary diagnosis in 40.4%.
- Prednisone monotherapy was the primary treatment for acute flares (72.3%).
- Only 15.4% of admissions achieved target serum urate levels; urate-lowering therapy was inadequately addressed in discharge plans.
Conclusions:
- Hospital admission rates for gout align with previous studies.
- Suboptimal initiation, adjustment, or recommendation of urate-lowering therapy during hospital admissions represents a missed opportunity for improving long-term gout management.
Objective:
Management of gout is frequently suboptimal. The aim of this study was to determine the proportion of patients presenting to Christchurch Hospital for a gout flare and to determine whether management for both acute flares and urate lowering was in accordance with international recommendations.
Methods:
A retrospective audit was undertaken of all admissions to Christchurch Hospital from June 1, 2013, to May 31, 2014, in which gout was coded as a primary or secondary discharge diagnosis. Information including demographics, comorbidities, concomitant medications, treatment of acute gout, and urate lowering was collected.
Results:
A total of 235 acute admissions for gout in 216 individuals were identified. Eleven individuals had 2 admissions and 4 individuals had 3 admissions. In 95/235 admissions (40.4%), gout was the primary diagnosis. Gout accounted for 95/77,321 (0.12%) of acute admissions. The treatment of acute gout was prednisone monotherapy in 170/235 (72.3%) of admissions. Serum urate was measured at some point during 123/235 (52.3%) of admissions, with only 19/123 (15.4%) at target urate level (< 0.36 mmol/l). At 60 of the 235 admissions, urate-lowering therapy was already being prescribed. Nine out of 175 patients (5.1%) not treated with urate-lowering therapy at admission commenced allopurinol and 32/174 (18.4%) had commencement of urate-lowering therapy recommended in the discharge plan.
Conclusion:
Rates of admission for gout are similar to that observed in other studies. Failure to initiate, change, or recommend alterations in urate-lowering therapy to achieve target urate in people with gout admitted to hospital represents a significant lost opportunity to improve longterm gout management.
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