Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares

Mark D Russell; Louise Ameyaw-Kyeremeh; Flora Dell'Accio; Heather Lapham; Natalie Head; Christopher Stovin; Vishit Patel; Benjamin D Clarke; Deepak Nagra; Edward Alveyn; Maryam A Adas; Katie Bechman; María A de la Puente; Benjamin Ellis; Corrine Byrne; Rina Patel; Andrew I Rutherford; Fleur Cantle; Sam Norton; Edward Roddy; Joanna Hudson; Andrew P Cope; James B Galloway

doi:10.1093/rheumatology/kead574

Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares

Mark D Russell, Louise Ameyaw-Kyeremeh, Flora Dell'Accio, Heather Lapham, Natalie Head, Christopher Stovin, Vishit Patel, Benjamin D Clarke, Deepak Nagra, Edward Alveyn, Maryam A Adas, Katie Bechman, María A de la Puente, Benjamin Ellis, Corrine Byrne, Rina Patel, Andrew I Rutherford, Fleur Cantle, Sam Norton, Edward RoddyJoanna Hudson, Andrew P Cope, James B Galloway

Centre for Rheumatic Diseases
1Department of Hepatology, Imperial College London, London, UK. 2Institute of Liver Studies at King's College School of Medicine at King's College Hospital, London, UK. 3Institute of Human Health and Performance, University College London, London, UK. 4Department of Asthma Allergy and Lung Biology, King's College London, London, UK. 5Division of Critical Care Medicine, University of Alberta, Edmonton, Canada.
KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST (HEATON)
Imperial College London
School of Medicine, Keele University, UK & University of Exeter, UK
Centre for Pain Research, University of Bath, Department of Experimental Psychology, University of Oxford, Department of Anaesthesiology & Pain Medicine, University of Washington, Clinical Health Psychology, University College London, and University College London Hospitals, and Psychology Department, Kings College London.
Health Psychology Section

Research output: Contribution to journal › Article › peer-review

Abstract

OBJECTIVES: To evaluate a strategy designed to optimise care and increase uptake of urate-lowering therapy (ULT) during hospitalisations for gout flares.

METHODS: We conducted a prospective cohort study to evaluate a strategy that combined optimal in-hospital gout management with a nurse-led, follow-up appointment, followed by handover to primary care. Outcomes, including ULT initiation, urate target attainment, and re-hospitalisation rates, were compared between patients hospitalised for flares in the 12 months post-implementation and a retrospective cohort of hospitalised patients from 12 months pre-implementation.

RESULTS: 119 and 108 patients, respectively, were hospitalised for gout flares in the 12 months pre- and post-implementation. For patients with 6-month follow-up data available (n = 94 and n = 97, respectively), the proportion newly initiated on ULT increased from 49.2% pre-implementation to 92.3% post-implementation (age/sex-adjusted odds ratio (aOR) 11.5; 95% confidence interval (CI) 4.36-30.5; p < 0.001). After implementation, more patients achieved a serum urate ≤360 micromol/L within 6 months of discharge (10.6% pre-implementation vs. 26.8% post-implementation; aOR 3.04; 95% CI 1.36-6.78; p = 0.007). The proportion of patients re-hospitalised for flares was 14.9% pre-implementation vs. 9.3% post-implementation (aOR 0.53, 95% CI 0.22 to 1.32; p = 0.18).

CONCLUSION: Over 90% of patients were initiated on ULT after implementing a strategy to optimise hospital gout care. Despite increased initiation of ULT during flares, recurrent hospitalisations were not more frequent following implementation. Significant relative improvements in urate target attainment were observed post-implementation; however, for the majority of hospitalised gout patients to achieve urate targets, closer primary-secondary care integration is still needed.

Original language	English
Journal	Rheumatology
DOIs	https://doi.org/10.1093/rheumatology/kead574
Publication status	E-pub ahead of print - 31 Oct 2023

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Russell, M. D., Ameyaw-Kyeremeh, L., Dell'Accio, F., Lapham, H., Head, N., Stovin, C., Patel, V., Clarke, B. D., Nagra, D., Alveyn, E., Adas, M. A., Bechman, K., de la Puente, M. A., Ellis, B., Byrne, C., Patel, R., Rutherford, A. I., Cantle, F., Norton, S., ... Galloway, J. B. (2023). Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares. Rheumatology. Advance online publication. https://doi.org/10.1093/rheumatology/kead574

@article{f3f7c64afd814fe185735238870871de,

title = "Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares",

abstract = "OBJECTIVES: To evaluate a strategy designed to optimise care and increase uptake of urate-lowering therapy (ULT) during hospitalisations for gout flares.METHODS: We conducted a prospective cohort study to evaluate a strategy that combined optimal in-hospital gout management with a nurse-led, follow-up appointment, followed by handover to primary care. Outcomes, including ULT initiation, urate target attainment, and re-hospitalisation rates, were compared between patients hospitalised for flares in the 12 months post-implementation and a retrospective cohort of hospitalised patients from 12 months pre-implementation.RESULTS: 119 and 108 patients, respectively, were hospitalised for gout flares in the 12 months pre- and post-implementation. For patients with 6-month follow-up data available (n = 94 and n = 97, respectively), the proportion newly initiated on ULT increased from 49.2% pre-implementation to 92.3% post-implementation (age/sex-adjusted odds ratio (aOR) 11.5; 95% confidence interval (CI) 4.36-30.5; p < 0.001). After implementation, more patients achieved a serum urate ≤360 micromol/L within 6 months of discharge (10.6% pre-implementation vs. 26.8% post-implementation; aOR 3.04; 95% CI 1.36-6.78; p = 0.007). The proportion of patients re-hospitalised for flares was 14.9% pre-implementation vs. 9.3% post-implementation (aOR 0.53, 95% CI 0.22 to 1.32; p = 0.18).CONCLUSION: Over 90% of patients were initiated on ULT after implementing a strategy to optimise hospital gout care. Despite increased initiation of ULT during flares, recurrent hospitalisations were not more frequent following implementation. Significant relative improvements in urate target attainment were observed post-implementation; however, for the majority of hospitalised gout patients to achieve urate targets, closer primary-secondary care integration is still needed.",

author = "Russell, {Mark D} and Louise Ameyaw-Kyeremeh and Flora Dell'Accio and Heather Lapham and Natalie Head and Christopher Stovin and Vishit Patel and Clarke, {Benjamin D} and Deepak Nagra and Edward Alveyn and Adas, {Maryam A} and Katie Bechman and {de la Puente}, {Mar{\'i}a A} and Benjamin Ellis and Corrine Byrne and Rina Patel and Rutherford, {Andrew I} and Fleur Cantle and Sam Norton and Edward Roddy and Joanna Hudson and Cope, {Andrew P} and Galloway, {James B}",

note = "{\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.",

year = "2023",

month = oct,

day = "31",

doi = "10.1093/rheumatology/kead574",

language = "English",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "OXFORD UNIV PRESS",

}

Russell, MD, Ameyaw-Kyeremeh, L, Dell'Accio, F, Lapham, H, Head, N, Stovin, C, Patel, V, Clarke, BD, Nagra, D , Alveyn, E , Adas, MA , Bechman, K, de la Puente, MA, Ellis, B, Byrne, C, Patel, R, Rutherford, AI, Cantle, F, Norton, S, Roddy, E, Hudson, J , Cope, AP & Galloway, JB 2023, 'Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares', Rheumatology. https://doi.org/10.1093/rheumatology/kead574

TY - JOUR

T1 - Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares

AU - Russell, Mark D

AU - Ameyaw-Kyeremeh, Louise

AU - Dell'Accio, Flora

AU - Lapham, Heather

AU - Head, Natalie

AU - Stovin, Christopher

AU - Patel, Vishit

AU - Clarke, Benjamin D

AU - Nagra, Deepak

AU - Alveyn, Edward

AU - Adas, Maryam A

AU - Bechman, Katie

AU - de la Puente, María A

AU - Ellis, Benjamin

AU - Byrne, Corrine

AU - Patel, Rina

AU - Rutherford, Andrew I

AU - Cantle, Fleur

AU - Norton, Sam

AU - Roddy, Edward

AU - Hudson, Joanna

AU - Cope, Andrew P

AU - Galloway, James B

PY - 2023/10/31

Y1 - 2023/10/31

N2 - OBJECTIVES: To evaluate a strategy designed to optimise care and increase uptake of urate-lowering therapy (ULT) during hospitalisations for gout flares.METHODS: We conducted a prospective cohort study to evaluate a strategy that combined optimal in-hospital gout management with a nurse-led, follow-up appointment, followed by handover to primary care. Outcomes, including ULT initiation, urate target attainment, and re-hospitalisation rates, were compared between patients hospitalised for flares in the 12 months post-implementation and a retrospective cohort of hospitalised patients from 12 months pre-implementation.RESULTS: 119 and 108 patients, respectively, were hospitalised for gout flares in the 12 months pre- and post-implementation. For patients with 6-month follow-up data available (n = 94 and n = 97, respectively), the proportion newly initiated on ULT increased from 49.2% pre-implementation to 92.3% post-implementation (age/sex-adjusted odds ratio (aOR) 11.5; 95% confidence interval (CI) 4.36-30.5; p < 0.001). After implementation, more patients achieved a serum urate ≤360 micromol/L within 6 months of discharge (10.6% pre-implementation vs. 26.8% post-implementation; aOR 3.04; 95% CI 1.36-6.78; p = 0.007). The proportion of patients re-hospitalised for flares was 14.9% pre-implementation vs. 9.3% post-implementation (aOR 0.53, 95% CI 0.22 to 1.32; p = 0.18).CONCLUSION: Over 90% of patients were initiated on ULT after implementing a strategy to optimise hospital gout care. Despite increased initiation of ULT during flares, recurrent hospitalisations were not more frequent following implementation. Significant relative improvements in urate target attainment were observed post-implementation; however, for the majority of hospitalised gout patients to achieve urate targets, closer primary-secondary care integration is still needed.

AB - OBJECTIVES: To evaluate a strategy designed to optimise care and increase uptake of urate-lowering therapy (ULT) during hospitalisations for gout flares.METHODS: We conducted a prospective cohort study to evaluate a strategy that combined optimal in-hospital gout management with a nurse-led, follow-up appointment, followed by handover to primary care. Outcomes, including ULT initiation, urate target attainment, and re-hospitalisation rates, were compared between patients hospitalised for flares in the 12 months post-implementation and a retrospective cohort of hospitalised patients from 12 months pre-implementation.RESULTS: 119 and 108 patients, respectively, were hospitalised for gout flares in the 12 months pre- and post-implementation. For patients with 6-month follow-up data available (n = 94 and n = 97, respectively), the proportion newly initiated on ULT increased from 49.2% pre-implementation to 92.3% post-implementation (age/sex-adjusted odds ratio (aOR) 11.5; 95% confidence interval (CI) 4.36-30.5; p < 0.001). After implementation, more patients achieved a serum urate ≤360 micromol/L within 6 months of discharge (10.6% pre-implementation vs. 26.8% post-implementation; aOR 3.04; 95% CI 1.36-6.78; p = 0.007). The proportion of patients re-hospitalised for flares was 14.9% pre-implementation vs. 9.3% post-implementation (aOR 0.53, 95% CI 0.22 to 1.32; p = 0.18).CONCLUSION: Over 90% of patients were initiated on ULT after implementing a strategy to optimise hospital gout care. Despite increased initiation of ULT during flares, recurrent hospitalisations were not more frequent following implementation. Significant relative improvements in urate target attainment were observed post-implementation; however, for the majority of hospitalised gout patients to achieve urate targets, closer primary-secondary care integration is still needed.

U2 - 10.1093/rheumatology/kead574

DO - 10.1093/rheumatology/kead574

M3 - Article

C2 - 37929968

SN - 1462-0324

JO - Rheumatology

JF - Rheumatology

ER -

Implementing treat-to-target urate-lowering therapy during hospitalisations for gout flares

Abstract

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