Open AccessPeripheral artery disease and risk of adverse outcomes in heart failure with preserved ejection fraction
Author(s) -
Sandesara Pratik B.,
Hammadah Muhammad,
SammanTahhan Ayman,
Kelli Heval M.,
O'Neal Wesley T.
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22716
Subject(s) - medicine , heart failure , hazard ratio , myocardial infarction , interquartile range , stroke (engine) , cardiology , ejection fraction , heart failure with preserved ejection fraction , adverse effect , confidence interval , mechanical engineering , engineering
Background Peripheral artery disease ( PAD ) in heart failure with preserved ejection fraction ( HFpEF ) is associated with an increased mortality risk, but the risk of individual outcomes associated with PAD in this patient group is less clear. Hypothesis PAD is associated with adverse outcomes in HFpEF , including hospitalization and specific cardiovascular outcomes. Methods We examined the association between PAD and adverse outcomes in 3385 patients with HFpEF (mean age, 69 ± 9.6 years; 49% male; 89% white) from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial ( TOPCAT ). Baseline PAD was identified by self‐reported history and medical‐record review. The following outcomes were adjudicated by a clinical endpoint committee: hospitalization, hospitalization for heart failure ( HF ), myocardial infarction, stroke, death, and cardiovascular death. Results Over a median follow‐up of 3.4 years (interquartile range, 2.0–4.9 years), an increased risk for hospitalization (hazard ratio [ HR ]: 1.36, 95% confidence interval [ CI ]: 1.16‐1.60), myocardial infarction ( HR : 1.69, 95% CI : 1.07‐2.67), death ( HR : 1.56, 95% CI : 1.22‐1.99), and cardiovascular death ( HR : 1.53, 95% CI : 1.12‐2.10) was observed for those with PAD compared with those without PAD . PAD was not associated with incident stroke. The association between PAD and hospitalization for HF was limited to participants with prior history of HF hospitalization (n = 2449; HR : 1.51, 95% CI : 1.09‐2.13). Conclusions PAD increases the risk for adverse outcomes in HFpEF and is associated with HF rehospitalization. Practitioners should be aware of the inherent risk associated with PAD in HFpEF .