• Davide Antonio Mei, Giulio Francesco Romiti, Tommaso Bucci, Bernadette Corica, Jacopo Francesco Imberti, Niccolò Bonini, Marco Vitolo, Alena Shantsila, Hung-Fat Tse, Tze-Fan Chao, Giuseppe Boriani, Marco Proietti, and LipGregory Y HGYHLiverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK. gregory.lip@liverpool.ac.uk.Department of Clinical Medicine, Aalborg University,.
• Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
• Bmc Med. 2024 Dec 2; 22 (1): 567567.

BackgroundIn patients with atrial fibrillation (AF), the impact of peripheral artery disease (PAD) on oral anticoagulant (OAC) therapy use and the risk of outcomes remains unclear.ObjectiveTo analyse the epidemiology of PAD in a large cohort of European and Asian AF patients, and the impact on treatment patterns and risks of adverse outcomes.MethodsWe analysed AF patients from two large prospective observational registries. OAC prescription and risk of outcomes were analysed according to the presence of PAD, using adjusted Logistic and Cox regression analyses. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). Interaction analyses were also performed.ResultsFifteen-thousand-four-hundred-ninety-seven patients with AF (mean age 68.9, SD 11.6 years; 38.6% female, 30% from Asia) were included in the analysis. PAD was found in 941 patients (6.1%), with a higher prevalence among European individuals compared to Asian (8.1% vs 1.2%, p < 0.001). On logistic regression analysis, European patients had sixfold higher odds of presenting with PAD compared with Asians (OR 6.23, 95% CI 4.75-8.35). After adjustments, PAD was associated with lower use of OAC (OR: 0.59, 95% CI: 0.50-0.69). On Cox regression analysis, PAD was associated with a higher risk of the primary composite outcome (HR 1.28, 95% CI: 1.08-1.52) and all-cause death (HR 1.40, 95% CI: 1.16-1.69). A significant interaction was observed between PAD and age, with higher effects of PAD found in younger patients (< 65 years) for the risk of the primary outcome (pint = 0.014).ConclusionsIn patients with AF, PAD is associated with lower use of OAC and a higher risk of adverse outcomes, with a greater risk seen in younger patients.© 2024. The Author(s).

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