A 2020 systematic review and meta-analysis discussed the prognostic value of uric acid (UA) levels in heart failure (HF) patients regardless of their coexisting kidney function, as higher UA levels were associated with poorer prognosis and adverse outcomes. Thus, the present review and meta-analysis (11 trials; N= 16,088) examined whether lowering serum UA (SUA) levels with UA-lowering agents has an effect on mortality, cardiovascular (CV) events, and left ventricular ejection fraction (LVEF) in patients with HF. Interestingly, the overall findings showed that allopurinol treatment did not result in measurable clinical benefits. Instead, allopurinol treatment was associated with a significantly increased risk for all-cause mortality (hazard ratio [HR]: 1.24, 95% confidence interval [CI], 1.04-1.49, p= 0.02) and a 42% increased risk in CV mortality (HR: 1.42, 95% CI, 1.11-1.81, p= 0.005). Moreover, there was a trend toward increased CV hospitalization with allopurinol treatment (HR: 1.21, 95% CI, 0.95-1.53, p= 0.12). Nonetheless, these findings need to be interpreted with caution given a high level of heterogeneity (heterogeneity X2= 37.3, I2= 73%, p<0.001). 
A 2017 review assessed the association between serum uric acid levels and multiple health outcomes, including heart failure. Five meta-analyses of observational studies were used to assess heart failure incidence in a total population of 427,917 patients; the association was considered to be highly suggestive, with an increased risk of heart failure with high serum uric acid levels (relative risk 1.65 (95% confidence interval 1.41 to 1.94). 
A 2020 review evaluated pathophysiological connections between elevated serum uric acid and heart failure with a focus on its prognostic impact. Approximately half of the patients with heart failure have a serum uric acid concentration above the upper limit normal based on results from a recent study by Palazzuoli et al. (Table 2). Additionally, serum uric acid levels can predict morbidity and mortality in mild to moderate and advanced heart failure cases, and evidence suggests that moderately elevated serum uric acid levels are independently associated with increased risk of adverse outcomes in patients with acute and chronic heart failure.