Risk factors for loss to follow-up in patients with gout: A Korean prospective cohort study
Hyunsue Do1, Chang-Nam Son2, Hyo Jin Choi3
1Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Republic of Korea.
Insights
Patients with gout experiencing fewer attacks but higher anxiety and depression are more likely to be lost to follow-up. Addressing mental health and quality of life is crucial for effective gout management.
Area of Science:
- Rheumatology
- Clinical Medicine
- Patient Outcomes
Background:
- Gout management often involves urate-lowering therapy.
- Patient adherence to treatment is frequently suboptimal, particularly between gout attacks.
- Loss to follow-up (LTFU) significantly hinders effective gout management.
Purpose of the Study:
- To identify patient characteristics associated with loss to follow-up (LTFU) in gout patients.
- To explore strategies for improving patient follow-up and management in gout care.
Main Methods:
- Analysis of prospective cohort data from the Urate Lowering TheRApy in gout (ULTRA) registry.
- Inclusion of adult gout patients meeting 2015 ACR/EULAR criteria.
- Collection of demographic, clinical, lifestyle, comorbidity, and quality of life data (K-GIS, EQ-5D).
- Definition of LTFU as missing clinic visits for over a year.
- Logistic regression analysis to identify predictors of LTFU.
Main Results:
- 46.5% of 269 patients were classified as LTFU.
- LTFU patients exhibited higher anxiety, depressive symptoms, impaired mobility, and poorer quality of life (EQ-5D).
- Frequent gout attacks, concerns about flares, anxiety, impaired mobility, and EQ-5D scores predicted LTFU.
Conclusions:
- Lower frequency of gout attacks, coupled with increased anxiety, depression, and reduced quality of life, are key indicators of LTFU.
- Enhanced patient support, including emotional and educational interventions, may improve follow-up rates.
- Targeted strategies addressing psychological well-being and functional status are essential for better gout management.
Objectives:
Gout, a common form of inflammatory arthritis, is often managed with urate-lowering therapy, but many patients only adhere to treatment during gout attacks, resulting in poor follow-up and suboptimal management. This study aimed to identify characteristics associated with loss to follow-up (LTFU) and develop strategies for better patient management.
Methods:
Data were analyzed from the Urate Lowering TheRApy in gout (ULTRA) registry, a prospective cohort of Korean gout patients recruited since September 2021. Patients aged 18 or older who met the 2015 ACR/EULAR classification criteria were included. Demographic data, clinical characteristics, lifestyle habits, comorbidities, and quality of life assessments using the Korean Gout Impact Scale (K-GIS) and EuroQol 5-Dimension (EQ-5D) were collected at baseline, six months, and annually. LTFU was defined as missing a clinic visit for more than a year. Logistic regression was used to determine factors associated with LTFU.
Results:
Among 269 patients, 125 (46.5%) were classified as LTFU. Patients not lost to follow-up experienced more frequent gout attacks (P = 0.020) and expressed greater concerns about future flares (P = 0.034). In contrast, LTFU patients had higher levels of anxiety (P = 0.049), depressive symptoms (P = 0.009), impaired mobility (P = 0.002), and a higher EQ-5D score (P = 0.002). Logistic regression identified frequent gout attacks, concerns about attacks, anxiety, impaired mobility, and EQ-5D scores as significant predictors of LTFU.
Conclusion:
Fewer gout attacks, heightened anxiety and depression, and lower quality of life were key factors associated with LTFU. Providing emotional support and comprehensive education may enhance follow-up and improve gout management.
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