Peripheral Artery Disease is Associated with Adverse Outcome among Hospitalized Patients with Decompensated Heart Failure

Patients with heart failure (HF) and peripheral artery disease (PAD) share common high co-morbidities and outcomes. Management of HF patients has changed dramatically in the last decade. Our purpose in this analysis was to describe the prognostic significance of PAD in a large contemporary cohort of HF patients.

METHODS: Analysis included consecutive patients who were hospitalized with decompensated HF between 2008-2020 at Sheba Medical Center. All patients` records were reviewed for the presence of PAD. Patients with cancer or chronic obstructive pulmonary disease were excluded from the analysis. Study outcomes were all-cause mortality and HF hospitalizations. Cox regression and propensity score matching models were applied.

RESULTS: Final study population included 8,216 patients of whom 548 (7%) had PAD. Patients with PAD had higher rates of co-morbidities. Median follow-up was 3 (IQR 1-7) years. PAD was associated with a significant 35% increased risk of re-admission and mortality in univariate analysis (p<.001 for both). Propensity score matching analysis has demonstrated that PAD patients had similar mortality rates, but higher re-hospitalization rates during follow up. Finally, sensitivity analysis of the matching model (n = 474), after excluding patients with RV dysfunction or severe pulmonary hypertension, successfully showed that HF patients with PAD were 50% more likely to be re-admitted and 30% more likely to die during follow-up (p=.02 and .006 respectively; Figure).

CONCLUSION: The presence of PAD identifies HF patients at risk for re-admissions and poor survival during follow-up. This is especially true for HF patients with preserved right sided pressure and function.