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Peripheral Arterial Disease in Patients with Atrial Fibrillation: The AFFIRM Study
Antonios Vitalis1, Alena Shantsila2, Marco Proietti3
1Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom; Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom; Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, United Kingdom.
Insights
Peripheral arterial disease (PAD) increases mortality in atrial fibrillation (AF) patients. PAD independently predicts ischemic stroke in non-anticoagulated AF patients, highlighting the need for vigilant management.
Area of Science:
- Cardiology
- Vascular Medicine
- Epidemiology
Background:
- Atrial fibrillation (AF) patients with peripheral arterial disease (PAD) experience poorer health outcomes.
- Understanding the specific impact of PAD on AF patient mortality and stroke risk is crucial.
Purpose of the Study:
- To evaluate the effect of peripheral arterial disease on mortality and stroke incidence in a large cohort of patients diagnosed with atrial fibrillation.
Main Methods:
- Ancillary analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial data.
- Comparison of baseline characteristics between AF patients with and without diagnosed PAD.
- Multivariate Cox regression analysis to assess risks of stroke, death, and cardiovascular death.
Main Results:
- 6.7% of 4060 AF patients had PAD, presenting with older age and more comorbidities.
- PAD was significantly associated with increased overall mortality (HR 1.34) in AF patients.
- PAD independently predicted ischemic stroke in non-anticoagulated AF patients (HR 3.37).
Conclusions:
- Peripheral arterial disease is a significant predictor of mortality in atrial fibrillation patients.
- PAD is an independent risk factor for ischemic stroke in non-anticoagulated AF patients.
- Enhanced surveillance and optimized medical management are recommended for AF patients with PAD.
Background:
Peripheral arterial disease has been linked with worse outcomes in patients with atrial fibrillation. The aim of this study is to assess the impact of peripheral arterial disease on mortality and stroke in a cohort of patients with atrial fibrillation.
Methods:
This was an ancillary analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial. A comparison of baseline characteristics was made between patients with atrial fibrillation with and without diagnosed peripheral arterial disease. Multivariate cox regression analysis was performed to compare the risk of stroke, death, and cardiovascular death among the two groups.
Results:
The prevalence of peripheral arterial disease in the whole cohort of 4060 patients with atrial fibrillation was 6.7%. Patients with peripheral arterial disease tended to be older; had higher prevalence of diabetes mellitus, hypertension, and smoking; and were more likely to have a history of coronary artery disease, heart failure, cardiac surgery or cardiac intervention, and stroke or transient ischemic attack (all P < .05). After multivariate adjustment, peripheral arterial disease was significantly associated with overall higher mortality (hazard ratio 1.34, 95% confidence interval 1.06-1.70, P = .016) in patients with atrial fibrillation, but the rates of ischemic stroke were similar in the two groups (3.9% vs 3.5%, P = 0.874). Subgroup analysis confined to the patients with non-anticoagulated atrial fibrillation showed that peripheral arterial disease was an independent predictor of ischemic stroke (hazard ratio 3.37, 95% confidence interval 1.25-9.09, P < .016).
Conclusion:
Peripheral arterial disease predicts higher mortality in atrial fibrillation, and was an independent predictor of ischemic stroke in patients with non-anticoagulated atrial fibrillation. Proactive surveillance and optimization of medical management in this group of patients is warranted, given the high risks associated with peripheral arterial disease where atrial fibrillation is also present.
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