Peripheral Arterial Disease in Patients with Atrial Fibrillation: The AFFIRM Study

Vitalis, Antonios, Shantsila, Alena ORCID: 0000-0002-0594-8576, Proietti, Marco ORCID: 0000-0003-1452-2478, Vohra, Rajiv K, Kay, Mark, Olshansky, Brian and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2021) Peripheral Arterial Disease in Patients with Atrial Fibrillation: The AFFIRM Study. AMERICAN JOURNAL OF MEDICINE, 134 (4). pp. 514-518.

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Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.

Item Type:	Article
Uncontrolled Keywords:	Atrial fibrillation, Peripheral arterial disease
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	20 Jun 2022 14:35
Last Modified:	18 Jan 2023 20:57
DOI:	10.1016/j.amjmed.2020.08.026
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3156685