{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T08:50:31Z","timestamp":1783759831072,"version":"3.55.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T00:00:00Z","timestamp":1766188800000},"content-version":"vor","delay-in-days":1816,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T00:00:00Z","timestamp":1609286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Japanese Ministry of Education, Culture, Sports, Science, and Technology and the Agency for Medical Research and Development","award":["16ek0210043h0002"],"award-info":[{"award-number":["16ek0210043h0002"]}]},{"name":"Japanese Ministry of Education, Culture, Sports, Science, and Technology and the Agency for Medical Research and Development","award":["16ek0210056h0001"],"award-info":[{"award-number":["16ek0210056h0001"]}]},{"name":"Japanese Ministry of Education, Culture, Sports, Science, and Technology and the Agency for Medical Research and Development","award":["15ek0210043h0001"],"award-info":[{"award-number":["15ek0210043h0001"]}]},{"DOI":"10.13039\/501100003478","name":"Japanese Ministry of Health, Labour, and Welfare","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003478","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Prognostic impacts of serum uric acid (UA) levels in patients with chronic heart failure (CHF) remain inconclusive, especially for the whole range of serum UA levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In the Chronic Heart Failure Registry and Analysis in the Tohoku District-2 (CHART-2) study, we enrolled 4652 consecutive patients with CHF and classified them into four groups based on baseline serum UA levels by the Classification and Regression Tree: G1 (&amp;lt;3.8 mg\/dL, N = 313), G2 (3.8\u20137.1 mg\/dL, N = 3070), G3 (7.2\u20139.2 mg\/dL, N = 1018), and G4 (&amp;gt;9.2 mg\/dL, N = 251). Mean age was 71 \u00b1 12, 69 \u00b1 12, 68 \u00b1 13, and 69 \u00b1 15 years in G1, G2, G3, and G4, respectively (P &amp;lt; 0.001). During the median follow-up of 6.3 years, in G1, G2, G3, and G4, 111 (35%), 905 (29%), 370 (36%), and 139 (55%) patients died and 79 (25%), 729 (24%), 300 (29%), and 115 (46%) experienced heart failure hospitalization, respectively (both P &amp;lt; 0.001). G1 was characterized by a significantly high prevalence of women as compared with G2, G3, and G4 (59%, 32%, 24%, and 23%, respectively). Serum creatinine levels (0.8 \u00b1 0.4, 0.9 \u00b1 0.4, 1.2 \u00b1 0.6, and 1.4 \u00b1 0.8 mg\/dL, respectively), prevalence of atrial fibrillation (34%, 39%, 45%, and 50%, respectively), and diuretics use (36%, 45%, 67%, and 89%, respectively) increased from G1, G2, G3 to G4 (all P &amp;lt; 0.001), while left ventricular ejection fraction decreased from G1, G2, G3 to G4 (59 \u00b1 15, 58 \u00b1 15, 54 \u00b1 15, and 52 \u00b1 17%, respectively, P &amp;lt; 0.001). Multivariable Cox proportional hazards models showed that, as compared with G2, both G1 and G4 had increased incidence of all-cause death [adjusted hazard ratio (aHR) 1.34, 95% confidence interval (CI) 1.08\u20131.67, P = 0.009; aHR 1.28, 95% CI 1.02\u20131.61, P = 0.037, respectively] and heart failure admission (aHR 1.39, 95% CI 1.09\u20131.78, P = 0.008 and aHR 1.35, 95% CI, 1.06\u20131.71, P = 0.014, respectively). This U-shaped relationship was evident in the elderly patients. Furthermore, abnormal transitions to either higher or lower levels of serum UA from G2 were associated with increased mortality (aHR 1.29, 95% CI 1.06\u20131.57, P = 0.012; aHR 1.57, 95% CI 1.12\u20132.20, P = 0.009).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These results demonstrate that serum UA levels have the U-shaped prognostic effects and abnormal transitions to either higher or lower levels are associated with poor prognosis in the elderly patients with CHF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.12765","type":"journal-article","created":{"date-parts":[[2020,12,30]],"date-time":"2020-12-30T15:58:47Z","timestamp":1609343927000},"page":"1027-1038","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Prognostic Impacts of Serum Uric Acid Levels in Patients with Chronic Heart Failure: Insights from the CHART-2 Study"],"prefix":"10.1093","volume":"8","author":[{"given":"Takahide","family":"Fujihashi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine , 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiko","family":"Sakata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine , 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 ,","place":["Japan"]},{"name":"Big Data Medicine Center, Tohoku University , Sendai ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kotaro","family":"Nochioka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine , 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 ,","place":["Japan"]},{"name":"Big Data Medicine Center, Tohoku University , Sendai ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanobu","family":"Miura","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine , 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruri","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine , 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shintaro","family":"Kasahara","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine , 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574 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