LAUSR

Background Hospitalizations complicated by gout flares have an impact on patient care. Delayed diagnosis and suboptimal management can lead to prolonged discomfort, impair chronic outcomes of the disease and lengthen the hospitalization (1). Patients on urate lowering therapy (ULT) are frequently admitted to the hospital for unrelated causes but there is variability in inpatient medication management of the urate lowering agent and acute management of the flare. Objectives In this descriptive study, we analyse the variability of reconciliation of ULT on admission and discharge and the impact of rheumatology consultation on acute and chronic management of gout. Methods Patients- above the age of 18- admitted to our tertiary care hospital from 01/01/2010 to 01/01/2016 with an ICD-9 or an ICD-10 diagnosis of gout were reviewed. The first 200 patients underwent a retrospective chart review as a pilot study for an ongoing project. We reviewed patient demographics, laboratory testing, and co-morbid conditions; medications on admission and discharge, incidence of gout flare- diagnosis and management during hospitalization, rheumatology consultation and discharge plan for these patients. Results Of the 200 patients reviewed, 2.69 admissions per person. We further described the patients who had a gout flare during hospitalization (n =54, 27%). 66% of these patients were males, mean age 69.8 years and BMI 31.78kg/m2. A majority of patients had hypertension, renal disease, and dyslipidemia (Table 1). 70% of the patients were on chronic medications for gout (Table 2). 29.6% of these patients were continued on these agents upon admission and only 64.8% of these patient was eventually discharged on these drugs. Rheumatology consulted for 68.5% of the patients. Arthrocentesis was more frequently performed when rheumatology was consulted (70% vs.17.6%; p<0.001). Rheumatology consultation did not decrease length of stay in the hospital. 78.5% of the patients managed by primary team were discharged on a ULT or colchicine compared to 100% in the group managed by rheumatology consult team (100% vs 78.5%; p<0.0431). Outpatient rheumatology follow up was documented in discharge papers for 62% of the patients managed with rheumatology consult compared to 11.7% in the comparison group. (62% vs 11.7%; p<0.002). Conclusion Rheumatology consultation improved adherence to guidelines in diagnosis and management of gout flare and improved the discharge planning and follow up. References [1] Robinson PC, Kempe S, et al. Epidemiology of inpatient gout in Australia and New Zealand: temporal trends, comorbidities and gout flare site. Int J Rheum Dis. 2016Jul26. doi: 10.1111/1756-185X.12941.Table 1 BASELINE DEMOGRAPHICS TOTAL PATIENTS (n =200 ) PATIENTS WITH A GOUT FLARE (n =54 ) RHEUMATOLOGY CONSULT (n= 37) PRIMARY TEAM (n= 17) Age (years) 70.99 ± 12.33 69.89 ± 11.28 70.62 ± 11.94 68.29 ± 9.82 RACE N(%)African-American/Caucasian/Others 164(82)/30(15)/6(3) 49(90.8)/3(5.5)/2(3.7) 32(86.4)/3(8)/2(5.4) 17(100)/0/0 BMI (kg/m2) 31.39 ± 9.21 31.79 ± 8.83 31.71 ± 7.75 31.94 ± 10.88 Hypertension 177(88.5) 48 (88.9) 32 (84) 16 (94) Diabetes mellitus 84 (42) 25 (46) 18 (48.6) 7 (41) Renal dysfunction 139 (69.5) 43 (79.6) 29 (78) 14 (41) Cardiovascular disease 119 (59.5) 25 (46.3) 17 (46) 8 (47)Table 2 TOTAL PATIENTS (n =200 ) PATIENTS WITH A GOUT FLARE (n =54 ) RHEUMATOLOGY CONSULT (n= 37) PRIMARY TEAM (n= 17) No of patient on chronic Gout medications N (%) 169 (84.5) 38 (70) 24 (64.8) 14 (82) Allopurinol/Febuxostat 139 (69.5)/2(1) 23 (42.6)/2 (3.7) 15 (40.5) 2 (5.4) 7 (41.2)/0 Colchicine 50 (25) 25 (46.3) 15 (40.5) 9 (52.9) Combination of drugs 22 (11) 12 (22.2) 8 (18.9) 2 (11.7) Inpatient Continuation of medication 117 (58.5) 16 (29.6) 10 (27) 6 (82) Medications on discharge 153 (76.5) 35 (64.8) 24(64.8) 11 (78.5) Length of Hospitalization (days) 5.00 ± 4.83 5.06 ± 2.56 4.73 ± 2.34 5.81 ± 2.99 Rheumatology follow up: N (%) 35 (17.5) 25 (46.3) 23 (62) 2 (11.7) Disclosure of Interests None declared