Severity of Peripheral Artery Disease Predicting Clinical Outcomes and 30-day Nonelective Readmission in Patients Admitted for Atrial Fibrillation.

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.