One-year all-cause mortality risk among atrial fibrillation patients in Middle East with and without diabetes: The Gulf SAFE registry

Abstract Backgroundand Aims: Atrial fibrillation (Afib) is associated with the incidence of lower extremity arterial disease (LEAD), but its effect on severe LEAD prognosis remains unclear. We investigated the association between Afib and clinical outcomes.Methods and ResultsWe retrospectively enrolled consecutive severe LEAD patients receiving percutaneous transluminal angioplasty between 2013/1/1 and 2018/12/31. Patients were divided by a history of any type of Afib and followed for at least one year. The primary outcome was all-cause mortality. Secondary outcomes were cardiac-related mortality, major adverse cardiovascular events (MACEs), and major adverse limb events (MALEs). The study included 222 patients aged 74 ± 11 years (54% male), and 12.6% had acute limb ischemia. The Afib group had significantly higher rates of all-cause mortality (42.9% vs. 20.1%, P = 0.014) and MACEs (32.1% vs. 14.4%, P = 0.028) than the non-Afib group. After adjustment for confounders, Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084–4.276, P = 0.029) and MACEs (adjusted HR: 2.338, 95% CI: 1.054–2.188, P = 0.037).ConclusionsAfib was significantly associated with increased risks of one-year all-cause mortality and MACEs in severe LEAD patients. Future studies should investigate whether oral anticoagulants benefit these patients.

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P6361Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

European Heart Journal ◽

10.1093/eurheartj/ehz746.0957 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Vidal-Perez ◽

R Agra-Bermejo ◽

D Pascual-Figal ◽

F Gude Sampedro ◽

C Abou Jokh ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Sinus Rhythm ◽

Acute Heart Failure ◽

Left Ventricular Ejection ◽

Long Term Outcomes ◽

All Cause Mortality ◽

One Year

Abstract Background The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. Purpose The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (HRD) (admission- discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentric, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results The mean age of the study population was 72±12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one-year all-cause mortality (Relative risk (RR)= 1.182, confidence interval (CI) 95% 1.024–1.366, p=0.022) in SR. In AF patients discharge HR was associated with one-year all-cause mortality (RR= 1.276, CI 95% 1.115–1.459, p≤0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction (Figure 1) Effect of post-discharge heart rate Conclusions In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients Acknowledgement/Funding Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and the Fondo Europeo de

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Impact of rate control medications on one-year outcomes with atrial fibrillation and heart failure

European Heart Journal ◽

10.1093/eurheartj/ehab724.0493 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

R Mo ◽

Y Yang ◽

L Yu

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Adverse Events ◽

Rate Control ◽

Cardiovascular Death ◽

Control Treatment ◽

All Cause Mortality ◽

One Year ◽

Cox Analysis ◽

The Impact

Abstract Purpose Atrial fibrillation (AF) and heart failure (HF) often coexist. The impact of rate-control regimens in AF and HF patients has not been well understood. Methods In this multicenter, prospective registry with one-year follow-up, 1359 persistent or permanent AF patients got enrolled. A 1:1 HF to non-HF propensity score matching was applied to adjust for confounding variables. The primary endpoint was all-cause mortality while the secondary endpoint was defined as cardiovascular death and stroke. Multivariate Cox analysis was performed to evaluate the association between different rate-control treatment and incidence of adverse events. Results Before matching, HF patients were much younger and more likely to be female. They had a much higher prevalence of previous myocardial infarction, chronic obstructive pulmonary disease and valvular heart disease. Among 1359 participants, we identified 1016 matched patients. The number of drugs did not affect the risk of all-cause mortality in both cohorts. For non-HF patients, using calcium channel blockers (CCBs) plus digoxin had a significant higher risk of all-cause death (HR=5.703, 95% CI 1.334–24.604, p=0.019) and cardiovascular death (HR=9.558, 95% CI 2.127–42.935, p=0.003) compared with patients not receiving rate-control treatment. The use of beta-blockers, CCBs, digoxin alone, other dual or triple combinations was not related to risk of adverse events in both groups. Conclusions The combined use of CCBs and digoxin was related to increase all-cause and cardiovascular mortality in AF patients without HF but not for those with HF. However, the ideal rate-control regimen for AF and HF patients has not been established and well-designed clinical trials are needed. FUNDunding Acknowledgement Type of funding sources: None. Results of multivariate Cox analysis Kaplan-Meier curves by drug numbers

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Trends in all-cause mortality of atrial fibrillation in hospitalized patients in Sweden between 1995–2008

European Heart Journal ◽

10.1093/eurheartj/ehab724.0296 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

A Sztaniszlav ◽

A Magnuson ◽

I L Bryngelsson ◽

N Edvardsson ◽

K Sztaniszlav ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mortality Risk ◽

Stroke Risk ◽

Education Level ◽

Hospitalized Patients ◽

Control Population ◽

High Morbidity ◽

Significant Difference ◽

All Cause Mortality ◽

Over Time

Abstract Introduction Atrial fibrillation (AF) is the most common arrythmia. Both its incidence and prevalence increased significantly during the last decades. AF is associated with high morbidity and mortality. Purpose The aim of this study was to describe and evaluate the trends of all-cause mortality in patients first-ever hospitalized for AF, and the effect of age, sex, stroke risk, and education level on mortality over time. Methods In this observational retrospective cohort study, we enrolled the patients who were hospitalized primarily and for the first time because of AF between 1st January 1995 and 31st December 2004. In regard to the date of the index admission patients were divided into four cohorts and they were followed up to five years. Patients were compared with an age and sex matched control population. All data were collected from Swedish national registries. Kaplan-Meier plots and Cox regression with trend analysis were used for statistical evaluation. Results In total 64 489 AF patients (mean age 72±10.1 year) were included in this study. The control group comprised 116 893 individuals. 81.9% of the women and 58.5% of the men were older than 65 years of age. 65.5% of women and 58.5% of the men had a stroke risk of CHADS2-VA2Sc ≥2. We found a significantly decreasing trend of the relative risk for all-cause mortality in AF patients over time: trend HR: 0.94 (95% CI: 0.92–0.96, p<0.001) in women and trend HR: 0.91 (95% CI: 0.89–0.93 p<0.001) in men. The mortality trends between AF patients and their controls did not show significant difference: trend HR: 0.99 (95% CI: 0.96–1.02, p=0.59) in women and trend HR: 1.00 (95% CI: 0.97–1.03, p=0.98) in men. The subpopulation analysis showed that the mortality risk remained unchanged over the time in women aged 18–69 years (trend HR: 0.91 – 95% CI: 0.82–1.02, p=0.099), in patients with low stroke risk (trend HR: 1.08 – 95% CI: 0.92–1.26, p=0.36 in women and trend HR: 0.95 – 95% CI: 0.87–1.05, p=0.30 in men) and in patients with post-secondary level of education (trend HR: 0.93 – 95% CI 0.83–1.04, p=0.23 in women and trend HR: 1.04 – 95% CI: 0.96–1.12, p=0.32 in men). Conclusion The all-cause mortality risk of the AF hospitalized patients was higher compared to control population and had a decreasing tendency during the time of the study. However, this trend is not significantly different from the control population. We found unchanged mortality trend in younger patients, in those with lower stroke risk, and in patients with higher education level. FUNDunding Acknowledgement Type of funding sources: None.

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Symptom status, clinical subtypes and prognosis in Middle East patients with atrial fibrillation: a report from the Gulf-SAFE registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0482 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y.G Li ◽

J Bai ◽

M Domek ◽

A Alsheikh-Ali ◽

W Almahmeed ◽

...

Keyword(s):

Atrial Fibrillation ◽

Middle East ◽

Odds Ratio ◽

Composite Outcome ◽

Gulf Region ◽

Prospective Survey ◽

Increased Risk ◽

All Cause Mortality ◽

Symptom Status ◽

Multivariable Adjustment

Abstract Background Atrial fibrillation (AF) is often asymptomatic. The prognosis of asymptomatic AF is similar or worse than symptomatic AF, but there are no such data from Middle East. Method The Gulf survey of AF events (Gulf SAFE) registry is a multi-center prospective survey of AF patients from six countries (23 centers) in the Gulf Region (n=2043). We investigated the prognostic outcomes of asymptomatic AF, in relation to clinical subtypes. Result 541 (26.5%) AF patients were asymptomatic; they tended to be older, with higher prevalence of hypertension, heart failure (HF), diabetes, stroke, renal dysfunction, and higher CHADS2, CHA2DS2-VASc, and HAS-BLED scores (all p<0.05). After multivariable adjustment, asymptomatic AF was associated with higher risks of stroke/systematic embolism (SE) (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.10–4.34), all cause-mortality (OR 2.85 [1.90–4.28]) and the composite outcome of stroke/SE, bleeding and all-cause mortality (OR 1.74 [1.26–2.41]). Asymptomatic AF was associated with fewer admissions for AF (OR 0.53 [0.32–0.83]) and HF (OR 0.58 [0.38–0.86]). The increased risk of stroke/SE in asymptomatic AF was associated with paroxysmal AF (Figure 1; P interaction=0.028). Conclusion In this large Middle East cohort, asymptomatic AF was common, less likely hospitalized but associated with unfavorable prognosis. When AF was asymptomatic, the paroxysmal subtype had a greater association with stroke/SE. Adjusted odds ratio of clinical outcomes Funding Acknowledgement Type of funding source: None

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P3858High H2FPEF score is an independent predictor of adverse outcome in patients with severe aortic stenosis and preserved ejection fraction undergoing TAVR

European Heart Journal ◽

10.1093/eurheartj/ehz745.0696 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Ludwig ◽

L Voigtlaender ◽

N Ruebsamen ◽

D Kalbacher ◽

B Koell ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Hypertension ◽

Aortic Stenosis ◽

Ejection Fraction ◽

Adverse Outcome ◽

Severe Aortic Stenosis ◽

Prognostic Impact ◽

Preserved Ejection Fraction ◽

All Cause Mortality ◽

One Year

Abstract Background Recently, the H2FPEF score has been developed in an evidence-based approach relying on simple clinical and echocardiographic variables. It enables the identification of patients with high probability of prevalent heart failure with preserved ejection fraction (HFpEF) which is associated with a dismal prognosis. Left ventricular diastolic dysfunction, a key mechanism in HFpEF, is also a common finding in patients with severe aortic stenosis. Objective To assess the prognostic impact of the H2FPEF score in patients with preserved ejection fraction and severe aortic stenosis undergoing Transcatheter Aortic Valve Replacement (TAVR). Methods Among 1148 patients with preserved ejection fraction who received TAVR at our institution between 2013 and 2018, data for calculation of the H2FPEF score was available in 535 patients. Score variables include BMI >30 kg/m2, arterial hypertension, atrial fibrillation, pulmonary hypertension >35 mmHg, age >60 years, and elevated LV filling pressure. Patients were dichotomized according to “low” (1–5 points; n=377) and “high” H2FPEF scores (6–9; n=158). Kaplan-Meier survival curves and Cox regression analyses were used to assess the prognostic impact of H2FPEF scores. Median follow-up time was 0.3 years. Results TAVR patients presenting with high H2FPEF scores had higher prevalence of moderate to severe mitral regurgitation (19.4% vs. 33.6%, p<0.001) as well as tricuspid regurgitation (15.2% vs. 35.1%, p<0.001), and presented with lower stroke volume index (42.2 ml/m2 vs. 36.0 ml/m2, p<0.001) compared to those with low H2FPEF scores. All-cause mortality one year after TAVR was significantly higher in patients in the high H2FPEF score group (10.5% vs. 21.0%, p=0.0019, Figure 1). Multivariate analysis revealed a high H2FPEF score to be independently predictive for 1-year all-cause mortality (HR 2.66, 95% CI: 1.41–5.02, p=0.025). Among the single H2FPEF score variables, atrial fibrillation (HR 3.45, 95% CI: 1.86–6.40, p<0.001) and systolic pulmonary hypertension >55 mmHg (HR=2.68, 95% CI: 0.97–7.40, p=0.057) were strong independent predictors of adverse outcome. Figure 1. All-cause mortality of patients undergoing TAVR after one year stratified by low (1–5 points) and high (6–9) H2FPEF score Conclusion An elevated H2FPEF score of >6 is independently predictive for mortality in patients with preserved ejection fraction undergoing TAVR for severe aortic stenosis. Our findings provide evidence that the H2FPEF score, which was meant for diagnostic use originally, is able to serve as a prognostic tool in patients with preserved ejection fraction undergoing TAVR, highlighting the adverse impact of diastolic dysfunction in patients with preserved ejection fraction and aortic stenosis.

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Association between serum potassium levels and short-term mortality in patients with atrial fibrillation or flutter co-treated with diuretics and rate- or rhythm-controlling drugs

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvz024 ◽

2019 ◽

Vol 6 (3) ◽

pp. 137-144 ◽

Cited By ~ 3

Author(s):

Louise Hagengaard ◽

Peter Søgaard ◽

Marie Espersen ◽

Maurizio Sessa ◽

Peter Enemark Lund ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mortality Risk ◽

Beta Blocker ◽

Cox Regression ◽

Beta Blockers ◽

Normal Range ◽

Short Term ◽

All Cause Mortality ◽

Short Term Mortality ◽

First Time

Abstract Aims We investigated the association between potassium levels and 90-day all-cause mortality in atrial fibrillation or flutter (AF) patients co-treated with diuretics and rate- or rhythm-controlling drugs. Methods and results During 2000–12, first-time AF patients treated with beta-blockers, amiodarone, sotalol, verapamil, or digoxin combined with any diuretic within 90 days post-AF discharge were included. Following co-treatment, a potassium measurement within 90 days after initiating diuretic treatment was required. Mortality risk associated with potassium <3.5, 3.5–3.7, 3.8–4.0, 4.5–4.7, 4.8–5.0, and >5.0 mmol/L (reference: 4.1–4.4 mmol/L) was assessed using multivariable Cox regression. In total, 14 425 AF patients were included (median age: 78 years; women: 52%). Patients most often received beta-blocker monotherapy (29%), beta-blockers and digoxin combined (25%), digoxin monotherapy (24%), amiodarone monotherapy (3%), and verapamil monotherapy (3%). Increased 90-day mortality risk was associated with <3.5 mmol/L [hazard ratio (HR) 2.05, 95% confidence interval (CI) 1.68–2.50], 3.5–3.7 mmol/L (HR 1.28, 95% CI 1.05–1.57), 4.5–4.7 mmol/L (HR 1.20, 95% CI 1.02–1.41), 4.8–5.0 mmol/L (HR 1.37, 95% CI 1.14–1.66), and >5.0 mmol/L: (HR 1.84, 95% CI 1.53–2.21). Compared with beta-blocker monotherapy, rate- or rhythm-controlling drugs did not modify the association between potassium groups and mortality risk. Conclusion In addition to hypo- and hyperkalaemia, low and high normal range potassium levels were associated with increased 90-day mortality risk in AF patients co-treated with diuretics and rate- or rhythm-controlling drugs. These associations were independent of rate- or rhythm-controlling drugs.

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Risks of Stroke and Mortality in Atrial Fibrillation Patients Treated With Rivaroxaban and Warfarin

Stroke ◽

10.1161/strokeaha.119.025554 ◽

2020 ◽

Vol 51 (2) ◽

pp. 549-555

Author(s):

Mark Alberts ◽

Yen-Wen Chen ◽

Jennifer H. Lin ◽

Emily Kogan ◽

Kathryn Twyman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Reduction ◽

Scale Score ◽

Mortality Risk ◽

National Institutes Of Health ◽

Stroke Severity ◽

Nonvalvular Atrial Fibrillation ◽

Severe Stroke ◽

Inverse Probability ◽

All Cause Mortality

Background and Purpose— Oral anticoagulation therapy is standard of care for patients with nonvalvular atrial fibrillation to prevent stroke. This study compared rivaroxaban and warfarin for stroke and all-cause mortality risk reduction in a real-world setting. Methods— This retrospective cohort study (2011–2017) included de-identified patients from the Optum Clinformatics Database who started treatment with rivaroxaban or warfarin within 30 days following initial diagnosis of nonvalvular atrial fibrillation. Before nonvalvular atrial fibrillation diagnosis, patients had 6 months of continuous health plan enrollment and CHA 2 DS 2 -VASc score ≥2. Stroke severity was determined by the National Institutes of Health Stroke Scale, imputed based on machine learning algorithms. Stroke and all-cause mortality risks were compared by treatment using Cox proportional hazard regression, with inverse probability of treatment weighting to balance cohorts for baseline risk factors. Stratified analysis by treatment duration was also performed. Results— During a mean follow-up of 27 months, 175 (1.33/100 patient-years [PY]) rivaroxaban-treated and 536 (1.66/100 PY) warfarin-treated patients developed stroke. The inverse probability of treatment weighting model showed that rivaroxaban reduced stroke risk by 19% (hazard ratio [HR], 0.81 [95% CI, 0.73–0.91]). Analysis by stroke severity revealed risk reductions by rivaroxaban of 48% for severe stroke (National Institutes of Health Stroke Scale score, 16–42; HR, 0.52 [95% CI, 0.33–0.82]) and 19% for minor stroke (National Institutes of Health Stroke Scale score, 1 to <5; HR, 0.81 [95% CI, 0.68–0.96]), but no difference for moderate stroke (National Institutes of Health Stroke Scale score, 5 to <16; HR, 0.93 [95% CI, 0.78–1.10]). A total of 41 (0.31/100 PY) rivaroxaban-treated and 147 (0.44/100 PY) warfarin-treated patients died poststroke, 12 (0.09/100 PY) and 67 (0.20/100 PY) of whom died within 30 days, representing mortality risk reductions by rivaroxaban of 24% (HR, 0.76 [95% CI, 0.61–0.95]) poststroke and 59% (HR, 0.41 [95% CI, 0.28–0.60]) within 30 days. Conclusions— After the initial diagnosis of atrial fibrillation, patients treated with rivaroxaban versus warfarin had significant risk reduction for stroke, especially severe stroke, and all-cause mortality after a stroke. Findings from this observational study may help inform anticoagulant choice for stroke prevention in patients with nonvalvular atrial fibrillation.

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Cardioversion in patients with newly diagnosed non-valvular atrial fibrillation: observational study using prospectively collected registry data

BMJ ◽

10.1136/bmj-2021-066450 ◽

2021 ◽

pp. e066450

Author(s):

Marita Knudsen Pope ◽

Trygve S Hall ◽

Valentina Schirripa ◽

Petra Radic ◽

Saverio Virdone ◽

...

Keyword(s):

Atrial Fibrillation ◽

Direct Current ◽

Newly Diagnosed ◽

Large Dataset ◽

Recent Onset ◽

Direct Current Cardioversion ◽

All Cause Mortality ◽

Pharmacological Cardioversion ◽

One Year

Abstract Objective To investigate the clinical outcomes of patients who underwent cardioversion compared with those who did not have cardioverson in a large dataset of patients with recent onset non-valvular atrial fibrillation. Design Observational study using prospectively collected registry data (Global Anticoagulant Registry in the FIELD-AF—GARFIELD-AF). Setting 1317 participating sites in 35 countries. Participants 52 057 patients aged 18 years and older with newly diagnosed atrial fibrillation (up to six weeks’ duration) and at least one investigator determined stroke risk factor. Main outcome measures Comparisons were made between patients who received cardioversion and those who had no cardioversion at baseline, and between patients who received direct current cardioversion and those who had pharmacological cardioversion. Overlap propensity weighting with Cox proportional hazards models was used to evaluate the effect of cardioversion on clinical endpoints (all cause mortality, non-haemorrhagic stroke or systemic embolism, and major bleeding), adjusting for baseline risk and patient selection. Results 44 201 patients were included in the analysis comparing cardioversion and no cardioversion, and of these, 6595 (14.9%) underwent cardioversion at baseline. The propensity score weighted hazard ratio for all cause mortality in the cardioversion group was 0.74 (95% confidence interval 0.63 to 0.86) from baseline to one year follow-up and 0.77 (0.64 to 0.93) from one year to two year follow-up. Of the 6595 patients who had cardioversion at baseline, 299 had a follow-up cardioversion more than 48 days after enrolment. 7175 patients were assessed in the analysis comparing type of cardioversion: 2427 (33.8%) received pharmacological cardioversion and 4748 (66.2%) had direct current cardioversion. During one year follow-up, event rates (per 100 patient years) for all cause mortality in patients who received direct current and pharmacological cardioversion were 1.36 (1.13 to 1.64) and 1.70 (1.35 to 2.14), respectively. Conclusion In this large dataset of patients with recent onset non-valvular atrial fibrillation, a small proportion were treated with cardioversion. Direct current cardioversion was performed twice as often as pharmacological cardioversion, and there appeared to be no major difference in outcome events for these two cardioversion modalities. For the overall cardioversion group, after adjustments for confounders, a significantly lower risk of mortality was found in patients who received early cardioversion compared with those who did not receive early cardioversion. Study registration ClinicalTrials.gov NCT01090362 .

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The impact of atrial fibrillation on one-year mortality in patients with severe peripheral artery diseases

European Heart Journal ◽

10.1093/ehjci/ehaa946.2360 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C.W Liu ◽

M.I Su

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Peripheral Artery ◽

Cardiac Events ◽

Significant Difference ◽

All Cause Mortality ◽

One Year ◽

The Impact

Abstract Background Atrial fibrillation (Afib) was associated with the incidence of peripheral artery disease (PAD), but the effect of Afib on prognosis in patients with severe PAD remains unclear. Purpose We aimed to investigate the association between Afib and clinical outcomes. Methods We retrospectively enrolled consecutive patients with severe PAD receiving percutaneous transluminal angioplasty between 2013/1/1 and 2018/12/31. The study outcomes were all-cause mortality, cardiac-related mortality, major adverse cardiac events (MACE), and major adverse limb events (MALE) at one-year. Results The study consisted of 222 patients with age 74±11 years, the stage of Rutherford classification 4.6±0.8, 54% male, and 12.6% presented with acute limb ischemia. The patients with Afib vs. without Afib had significantly greater ratios of all-cause mortality (42.9% vs. 20.1%, P=0.014) and MACE (32.1% vs. 14.4%, P=0.028). A trend toward significant association was found regarding one-year cardiac mortality (21.4% vs. 10.3%, P=0.111). No significant difference was found with respect of MALE (17.9% vs. 14.9%, P=0.778). After we adjusted for confounders in each study outcome, Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084–4.276, P=0.029) and MACE (adjusted HR: 2.338, 95% CI: 1.054–2.188, P=0.037). Other predictors associated with all-cause mortality included the presence of acute limb ischemia (adjusted HR: 2.898, 95% CI: 1.504–5.586, P=0.001), Rutherford classification (adjusted HR: 1.930, 95% CI: 1.191–3.128, P=0.008), and heart rate (adjusted HR: 1.018, 95% CI: 1.001–1.035, P=0.035). The other predictor associated with MACE was heart rate (adjusted HR: 1.020, 95% CI: 1.002–1.037, P=0.025) Conclusions Afib was significantly associated with increased risks of all-cause mortality and MACE at one year in the patients with severe PAD, and future studies may investigate whether use of oral anti-coagulants benefits to these patients. Funding Acknowledgement Type of funding source: None

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