Atrial fibrillation in a cohort of patients with peripheral arterial disease. A retrospective study of a healthcare database in UK

Abstract Atrial fibrillation in a cohort of patients with peripheral arterial disease. A retrospective study of a healthcare database in UK. Background There is strong evidence that peripheral arterial disease (PAD) is linked with worse outcomes in patients with atrial fibrillation (AF), which has led vascular disease to be included as one of the components of CHA2DS2-VASc score for risk stratification in AF. On the other hand, very limited evidence exists on the prognostic implication of AF in patients with PAD. Purpose The aim of this study is to identify the prevalence of AF in a cohort of PAD patients and demonstrate its association with adverse cardiovascular outcomes, limb loss and mortality. Methods This is a retrospective study of The Health Improvement Network (THIN) database, which contains computerized records from primary care physicians, covering more than 11 million patients from over 600 general practices in the UK. During the studied period from 1995 to 2017, 55540 patients with newly diagnosed PAD have been detected in the database and baseline characteristics, coexisting medical diagnoses (including AF), relevant medication and subsequent outcomes have been recorded using appropriately selected clinical codes (READ codes). A comparison of baseline characteristics was made between patients with PAD and AF and those without AF using descriptive statistics. Multivariate cox regression analysis was then performed and hazard rations for mortality, stroke or transient ischaemic attack (TIA), ischaemic heart disease (IHD), heart failure (HF) and major lower limb amputation at presence of AF were calculated, after adjustment for age, sex, ethnicity, BMI, smoking, Townsend comorbidity index, diabetes, hypertension, kidney function, and medication (lipid- lowering, antiplatelets, anticoagulants). Results From the 55540 patients with new diagnosis of PAD during the study period, 5685 (10.2%) had coexisting AF. Patients with AF were older, had higher prevalence of diabetes, hypertension and renal failure, were more likely to be on anticoagulants, antiplatelets and lipid lowering agents, were more likely to be ex-smokers but less likely to be active smokers. Mean follow up period was 5.1 (SD= 4) years. After adjustment for confounders, AF patients were at higher risk for death (HR: 1.30, 95% CI 1.24- 1.37, p<0.01) for stroke or TIA (HR: 1.46, 95% CI 1.29- 1.65, p<0.01) and for HF (HR: 1.85, 95% CI 1.65- 2.08, p<0.01). There was no significant association between AF and development of IHD (p=0.34) and limb loss (p=0.14) in this cohort. Conclusion AF is a predictor of worse prognosis in patients with PAD. Close monitoring and medical optimization of these patients is warranted. Funding Acknowledgement Type of funding source: None

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Endovascular treatment of diabetic peripheral arterial disease in older and oldest old patients: a retrospective study

Aging Clinical and Experimental Research ◽

10.1007/s40520-017-0760-5 ◽

2017 ◽

Vol 30 (2) ◽

pp. 205-207 ◽

Cited By ~ 2

Author(s):

Cristina Gatti ◽

Sara Cecchini ◽

Paolo Fabbietti ◽

Fabio Romagnoli ◽

Stefano Ricci

Keyword(s):

Retrospective Study ◽

Peripheral Arterial Disease ◽

Endovascular Treatment ◽

Oldest Old ◽

Arterial Disease ◽

Old Patients ◽

Peripheral Arterial

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The Role of Tobacco Cessation, Antiplatelet and Lipid-Lowering Therapies in the Treatment of Peripheral Arterial Disease

Vascular Medicine ◽

10.1177/1358863x9700200314 ◽

1997 ◽

Vol 2 (3) ◽

pp. 243-251 ◽

Cited By ~ 81

Author(s):

Alan T Hirsch ◽

Diane Treat-Jacobson ◽

Harry A Lando ◽

Dorothy K Hatsukami

Keyword(s):

Peripheral Arterial Disease ◽

Arterial Disease ◽

Pharmacological Therapy ◽

Current Data ◽

Lipid Lowering ◽

History Of ◽

Medical Therapies ◽

Peripheral Arterial ◽

Interventional Therapies

Despite the widely held belief that there are no effective medical therapies for peripheral arterial disease (PAD), current data suggest that medical therapies can effectively modify the natural history of atherosclerotic lower extremity arterial occlusive disease. The ideal medical therapy would improve claudication, forestall the onset of limb-threatening events, decrease rates of invasive interventional therapies and improve long-term patient survival. These ideal outcomes might be achieved through the use of smoking cessation interventions, including behavioral and pharmacological therapy, and the administration of antiplatelet and lipid-lowering medications in patients with PAD.

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Abstract P250: Incidence of Hospitalized Peripheral Arterial Disease and Critical Limb Ischemia: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.125.suppl_10.ap250 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Corey A Kalbaugh ◽

Anna Kucharska-Newton ◽

Laura Loehr ◽

Elizabeth Selvin ◽

Aaron R Folsom ◽

...

Keyword(s):

Risk Factors ◽

African Americans ◽

Peripheral Arterial Disease ◽

Lower Extremity ◽

Limb Ischemia ◽

Arterial Disease ◽

Atherosclerosis Risk In Communities ◽

Atherosclerosis Risk ◽

Baseline Characteristics ◽

Peripheral Arterial

Introduction: Lower extremity peripheral arterial disease (PAD) affects between 12% and 20% of Americans over the age of 65. PAD compromises quality of life, contributes a high burden of disability and its related health care costs exceed $4 billion/year, yet this preventable CVD outcome remains understudied. Aims: Assess the incidence of hospitalized PAD, and of the most severe form of PAD, critical limb ischemia (CLI), in middle-aged men and women, and evaluate their risk factors in a bi-ethnic, population-based cohort. We hypothesized that incidence of hospitalized PAD and CLI are higher in African Americans, and that modifiable atherosclerosis risk factors in middle age predict these sequelae of PAD. Methods: We analyzed data from 13,865 participants from the Atherosclerosis Risk in Communities Study aged 45–64 without PAD at baseline (1987–89). Incident PAD and CLI events were identified using ICD-9 codes from active surveillance of all hospitalizations among cohort participants from 1987 through 2008. All estimates are incidence rates per 10,000 person-years; nominal statistical significance was achieved for all baseline characteristic comparisons reported. Results: There were 707 incident hospitalized PAD during a median of 18 years of follow-up (249,570 person-years). The overall age-adjusted incidence of PAD and limb-threatening CLI were 26.0 and 9.6 per 10,000 person-years, respectively. Incidence of hospitalized PAD was higher in African Americans than whites (34.7 vs. 23.2) and in men compared to women (32.4 vs. 26.7). Baseline characteristics associated with age-adjusted incident PAD (per 10,000 person-years) compared to their referent groups were diabetes (91.2 vs. 19.0), history of smoking (33.6 vs. 16.2), hypertension (42.6 vs. 18.6), coronary heart disease (81.4 vs. 24.1), and obesity (41.5 vs. 20.2). Incidence of CLI also was higher among African Americans (21.0 vs. 5.9) and in men (10.5 vs. 8.9 per 10,000 person-years). Baseline characteristics associated with incident CLI were similar to those for PAD. Conclusions: The absolute risk of hospitalized lower extremity PAD in this community-based cohort is of a magnitude similar to that of heart failure and of stroke. As modifiable factors are strongly predictive of the long-term risk of hospitalized PAD and CLI, particularly among African Americans, our results highlight the need for effective risk factor prevention and control.

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