Hospitalized Patients with Gout Show Increased Rates of Concomitant VTE

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A recent investigation has uncovered that 10% of hospitalizations among patients with gout involved a concomitant diagnosis of venous thromboembolism (VTE), highlighting significant clinical and economic consequences for these individuals.¹

The research, presented at the American College of Rheumatology 2023 Convergence in San Diego, California, collected data from the National Inpatient Sample (NIS), a stratified random sample of all US community hospitals created to output national estimates of inpatient utilization, price, and outcomes.

These data indicated a higher occurrence of VTE among hospitalized patients with gout aged ≥45 years, compared to non-hospitalized individuals (1 in 10 versus 1 in 12 patients), and was associated with a significant economic burden.

“These findings suggest that VTE prevention measures and patient education on VTE signs and symptoms may be of particular importance in patients with gout,” wrote the investigative team, led by Gurkirpal Singh, MD, chief science officer of the Institute of Clinical Outcomes Research and Education (ICORE) and an adjunct clinical professor of medicine, division of gastroenterology and hepatology, Stanford University School of Medicine.

VTE is a condition when a blood clot forms in a vein, exhibited by deep venous thrombosis (DVT) and pulmonary embolism (PE).² It is a common medical condition, with an estimated incidence of 1 to 2 per 1000 person-years. VTE development has been linked to a significant mortality rate, with numbers suggesting 11 t30% per annum.

Despite the known association of VTE with surgery, immobilization, and cancer, some evidence has noted an increased VTE risk among individuals with gout – however, there is limited nationally representative data in the US on the clinical and economic consequences of VTE in gout.¹

In this analysis, a team of investigators, led by Singh, assessed VTE hospitalization among patients with gout in the US to estimate the disease's clinical and economic impact. The NIS, a stratified random sample of all US community hospitals, is the only US national hospital database with information on all patients, regardless of payer. Those covered by Medicare, Medicare, and private insurance, as well as the uninsured, are included in the database.

Overall, unweighted, the database consisted of data from approximately 7 million hospitalizations a year; the weighted data estimated around 35 million annual hospitalizations. Singh and colleagues examined all inpatient hospitalizations in the NIS in 2020, the most recent year available in the database, with a primary or secondary diagnosis of gout and VTE.

Upon analysis, in 2020, investigators found there were 32.4 million all-cause hospitalizations in the US, with 19.7 million occurring in individuals ≥45 years old. Patients had a mean age of 71.8 years (95% CI, 71.7 - 71.9 years) and the population was more likely to be male (68.8%). Among these individuals, 785,905 hospitalizations occurred in people aged ≥45 years with a gout diagnosis.

Of these hospitalizations, a total of 79,260 (10.1%) also reported a concomitant diagnosis of VTE. In contrast, only 8.2% of hospitalizations in the general population ≥45 years reported a concomitant diagnosis of VTE (P <.001).

Those with gout and VTE had a mean age of 71.6 years (95% CI, 71.4 - 71.8 years) and consisted of mostly men (66%). Cost analyses showed the average costs per hospitalization were $76,373 (95% CI, 73,343 - 79,403), with a total annual national cost of more than $6.1 billion.

References

1. _{Mithal A, Sehgal M, LaMoreaux B, Singh G. Venous Thromboembolism in Patients with Gout in the US. Presented at: American College of Rheumatology Convergence 2023. San Diego, CA. November 10-15, 2023.}
2. _{What is venous thromboembolism? National Heart Lung and Blood Institute. September 19, 2022. Accessed November 20, 2023. https://www.nhlbi.nih.gov/health/venous-thromboembolism.}