Association between allopurinol and mortality in heart failure patients: a long-term follow-up study

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Abstract
Aims: The aim of the study was to explore the long‐term effect of allopurinol on mortality and cardiovascular hospitalisations in heart failure (HF) patients. Methods: This is a population‐based cohort study using a record‐linkage database in Tayside, Scotland. A total of 4785 HF patients (4260 non‐users, 267 incident users and 258 prevalent users) were studied between 1993 and 2002. Results: Compared with non‐users, low‐dose users in the incident group had a significant increased risk of all‐cause mortality, cardiovascular mortality and cardiovascular recurrence (adjusted HR, 1.60, 95%CI 1.26–2.03; 1.70, 1.29–2.23 and 1.44, 1.01–2.07). For the prevalent users, the adjusted HR were 1.27, 0.98–1.64; 1.43, 1.07–1.90 and 1.27, 0.91–1.76 respectively. There was no increased risk of outcome for high‐dose users when compared with non‐users (adjusted HR, 1.18, 0.84–1.66; 1.14, 0.76–1.71 and 1.36, 0.88–2.10 for the incident users, and 0.86, 0.64–1.15; 0.90, 0.64–1.26; and 1.27, 0.93–1.74 for the prevalent users respectively). High‐dose allopurinol was associated with reduced risk of all‐course mortality for prevalent users when compared with low‐dose (adjusted HR 0.65, 95%CI 0.42–0.99). Conclusions: The prevalent high‐dose allopurinol use had a lower risk of mortality than the prevalent low‐dose use suggesting that allopurinol may be of benefit in HF patients.