Critical pathways in cardiology · 2025
Severity of Peripheral Artery Disease Predicting Clinical Outcomes and 30-day Nonelective Readmission in Patients Admitted for Atrial Fibrillation.
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Ascandar Nameer, Simon Joshini, Steinhoff Jeffrey P, Bera Reetom, Tian Herschel
Аннотация
BACKGROUND: While peripheral artery disease (PAD) is a recognized risk factor for other macrovascular diseases, including coronary artery disease, the impact of PAD severity in patients hospitalized for atrial fibrillation (AF) remains underexplored. Using a nationally representative cohort of patients admitted for AF, we examined clinical outcomes in those with different PAD severities and compared them to patients without PAD.
METHODS: Data were obtained from the 2016 to 2022 Nationwide Readmissions Database to query all patients admitted for AF. Patients were categorized into 3 groups: No PAD (non-PAD), PAD, and critical limb ischemia (CLI). Multivariable regression models were constructed to adjust for patient and hospital-level factors and to examine the association between PAD severity and outcomes in patients admitted for AF.
RESULTS: Out of 6,715,236 AF admissions, 4.5% had PAD, 0.3% had CLI, and the remaining were non-PAD. Following risk adjustment, in-hospital mortality was higher by 22% in PAD [adjusted odds ratio (aOR) 1.22, 95% confidence interval (CI), 1.07-1.39], and 264% in CLI (aOR, 3.64, 95% CI, 1.36-9.73), compared to non-PAD. Only PAD was linked with higher odds of acute ischemic stroke (aOR, 1.27, 95% CI, 1.12-1.44). However, the duration of hospital stay, hospitalization costs, and odds of nonhome discharge and 30-day nonelective readmissions were greater in patients with PAD and CLI compared to non-PAD patients.
CONCLUSION: Severe PAD was linked with significantly worse clinical outcomes, including higher in-hospital mortality, longer length of stay, incremental hospitalization costs, and higher 30-day nonelective readmission. These outcomes underscore the importance of early PAD management.
METHODS: Data were obtained from the 2016 to 2022 Nationwide Readmissions Database to query all patients admitted for AF. Patients were categorized into 3 groups: No PAD (non-PAD), PAD, and critical limb ischemia (CLI). Multivariable regression models were constructed to adjust for patient and hospital-level factors and to examine the association between PAD severity and outcomes in patients admitted for AF.
RESULTS: Out of 6,715,236 AF admissions, 4.5% had PAD, 0.3% had CLI, and the remaining were non-PAD. Following risk adjustment, in-hospital mortality was higher by 22% in PAD [adjusted odds ratio (aOR) 1.22, 95% confidence interval (CI), 1.07-1.39], and 264% in CLI (aOR, 3.64, 95% CI, 1.36-9.73), compared to non-PAD. Only PAD was linked with higher odds of acute ischemic stroke (aOR, 1.27, 95% CI, 1.12-1.44). However, the duration of hospital stay, hospitalization costs, and odds of nonhome discharge and 30-day nonelective readmissions were greater in patients with PAD and CLI compared to non-PAD patients.
CONCLUSION: Severe PAD was linked with significantly worse clinical outcomes, including higher in-hospital mortality, longer length of stay, incremental hospitalization costs, and higher 30-day nonelective readmission. These outcomes underscore the importance of early PAD management.