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