Peripheral artery disease and clinical outcomes in patients with atrial fibrillation: A systematic review and meta‐analysis

Abstract

Background Atrial fibrillation (AF) is the most common cardiac rhythm disturbance and leads to morbidity and mortality. Peripheral artery disease (PAD) is associated with atherosclerotic risk factors and always classified as a vascular disease and deemed to be a bad complication of AF. In patients with AF, the risk and prognostic value of PAD have not been estimated comprehensively. Hypothesis PAD is associated with all‐cause mortality, cardiovascular (CV) mortality, and other outcomes in patients with AF. Methods We searched PubMed, Embase, and Cochrane Library databases for prospective studies published before April 2021 that provided outcomes data on PAD in confirmed patients with AF. Heterogeneity was estimated using the I2 statistic. The fixed‐effects model was used for low to moderate heterogeneity studies, and the random‐effects model was used for high heterogeneity studies. Results Eight prospective studies (Newcastle‐Ottawa score range, 7–8) with 39 654 patients were enrolled. We found a significant association between PAD and all‐cause mortality (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.25–1.62; p < .001), CV mortality (HR, 1.64; 95% CI, 1.32–2.05; p < .001) and MACE (HR, 1.75; 95% CI, 1.38–2.22; p < .001) in patients with AF. No significant relationship was found in major bleeding (HR, 1.22; 95% CI, 0.95–1.57; p = 0.118), myocardial infarction (MI) (HR, 2.07; 95% CI, 1.17–3.67; p = .038), and stroke (HR, 1.14; 95% CI, 0.87–1.50, p = 0.351). Conclusions PAD is associated with an increased risk of all‐cause mortality, CV mortality, and MACE in patients with AF. However, no significant association was found with major bleeding, MI, and stroke.

Combined use of anticoagulant and antiplatelet on outcome after stroke in patients with nonvalvular atrial fibrillation and systemic atherosclerosis

“…Furthermore, approximately one-third of the patients had atherosclerotic disease with two or more arterial beds. In addition, if any atherosclerotic diseases are present, cerebro-cardiovascular outcomes could be worse among patients with atrial fibrillation 5 , 13 , 14 . Therefore, there are concerns regarding the management of patients with NVAF and systemic atherosclerosis.…”

Direct Oral Anticoagulants as the First Choice of Anticoagulation for Patients with Peripheral Artery Disease to Prevent Adverse Vascular Events: A Systematic Review and Meta-Analysis

“…In a meta-analysis examining the relationship between AF and PAD, Zhu et al stated [ 43 ] that the occurrence of PAD in patients with AF could increase the risk and incidence of several adverse clinical events, including all-cause mortality, cardiovascular (CV) death and MACE; however, they did not find a statistically significant difference in the incidence of major bleeding, myocardial infarction (MI), and stroke among AF patients with and without PAD.…”

How to assess the impact of diagnosis‐to‐ablation time in patients with early‐onset atrial fibrillation

“…Notably, 5% of subjects in the authors' study exhibited heart failure. 1 Clarity regarding the authors' methodology for diagnosing concurrent heart failure is imperative.…”

“…Furthermore, the authors' definition of cardiac rehospitalization lacks precision. 1 It seemingly encompasses acute coronary syndrome, which may not inherently correlate with atrial fibrillation. A preferable approach might entail segregating heart failure rehospitalization to better discern the intricate association between atrial fibrillation and heart failure.…”

“…time correlates with diminished susceptibility to cardiovascular incidents and recurrent atrial fibrillation among patients exhibiting early-onset atrial fibrillation. 1 However, several pivotal concerns have been raised.…”