Peripheral arterial disease in patients with atrial fibrillation: The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study.

Vitalis, Antonios, Shantsila, Alena, Proietti, Marco, Vohra, Rajiv K, Kay, Mark, Olshansky, Brian and Lip, Gregory Y H (2020) Peripheral arterial disease in patients with atrial fibrillation: The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study. The American journal of medicine. ISSN 1555-7162. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Abstract

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 atrial fibrillation patients.

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 atrial fibrillation patients 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 atrial fibrillation patients was 6.7%. Patients with peripheral arterial disease tended to be older, had higher prevalence of diabetes mellitus, hypertension and smoking, they were more likely to give a history of coronary artery disease, heart failure, cardiac surgery or cardiac intervention and stroke or TIA (all p<0.05). After multivariate adjustment, peripheral arterial disease was significantly associated with overall higher mortality (HR: 1.34, 95%CI 1.06- 1.70, p= 0.016) in atrial fibrillation patients, but the rates of ischaemic stroke were similar in the two groups (3.9% vs 3.5%, p= 0.874). Subgroup analysis confined to the non-anticoagulated atrial fibrillation patients showed that peripheral arterial disease was an independent predictor of ischaemic stroke (HR: 3.37, 95%CI 1.25- 9.09, p< 0.016).

CONCLUSION

Peripheral arterial disease predicts higher mortality in atrial fibrillation, and was an independent predictor of ischaemic stroke in non-anticoagulated atrial fibrillation patients. 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
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
WO Surgery
Divisions: Emergency Services > Cardiology
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 28 Sep 2020 14:26
Last Modified: 28 Sep 2020 14:26
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3478

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