Peripheral Arterial Disease in Patients with Atrial Fibrillation: The AFFIRM Study |
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| Authors: | Antonios Vitalis Alena Shantsila Marco Proietti Rajiv K. Vohra Mark Kay Brian Olshansky Gregory Y.H. Lip |
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| Affiliation: | 1. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, United Kingdom;2. Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom;3. Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, United Kingdom;4. Department of Clinical Sciences and Community Health, University of Milan, Italy;5. Geriatric Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy;6. University of Iowa Carver College of Medicine, Iowa City;7. Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark;1. Division of General Internal Medicine, Massachusetts General Hospital, Boston, Mass;2. Harvard Medical School, Boston, Mass;3. Department of Internal Medicine, McLean Hospital, Belmont, Mass;1. Department of Medicine, Oregon Health and Science University, Portland;2. Department of General Internal Medicine, Kobe City Medical Center General Hospital, Kobe, Japan;1. Scientist, KARE Biosciences, Las Vegas, Nevada;2. Department of Medicine, School of Medicine, University of California Irvine, Irvine;1. Department of General Medicine, Chiba University Hospital, Chiba, Japan;2. Department of General Medicine, Yokohama City University School of Medicine, Kanagawa, Japan;1. Department of Neurology, Kagawa University Faculty of Medicine, Miki, Japan;2. Department of General Internal Medicine, Kagawa University Faculty of Medicine, Miki, Japan;3. Department of Intractable Neurological Research, Kagawa University, Faculty of Medicine, Miki, Japan;4. Department of Gastroenterology, Kagawa University Faculty of Medicine, Miki, Japan;5. Department of Health Sciences, Kagawa University Faculty of Medicine, Miki, Japan |
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| Abstract: | BackgroundPeripheral 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.MethodsThis 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.ResultsThe 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).ConclusionPeripheral 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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| Keywords: | Atrial fibrillation Peripheral arterial disease |
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