title: Atrial fibrillation is a risk marker for worse in-hospital and long-term outcome in patients with peripheral artery disease.
abstract: OBJECTIVE
  To investigate the relevance of atrial fibrillation or flutter (AF) for outcome of patients who are hospitalized for peripheral artery disease (PAD) and/or critical limb ischemia (CLI).
  
  
  RESULTS
  We compared baseline data, co-morbidities, procedural data as well as in-hospital and long-term outcome of 41,882 patients who were hospitalized with PAD or CLI between 2009 and 2011 according to whether they did or did not have atrial fibrillation/flutter. Follow-up was available until December 2012. Of these, 5622 patients (13.4%) had AF. AF patients were significantly older (78±9 vs. 70±11years) and had significantly more comorbidities, such as diabetes (40.8 vs. 31.1%), chronic kidney disease (40.1 vs. 19.0%), coronary artery disease (38.0 vs. 23.0%) and chronic heart failure (26.9 vs. 7.2%, each p<0.001). They had more advanced PAD as shown by higher Rutherford classes. In-hospital complications including acute renal failure, myocardial infarction, stroke sepsis and death occurred significantly more often (each p<0.001). Duration of hospital stay was significantly longer and costs were markedly higher in patients with AF (each p<0.001). Using multivariate Cox regression analyses regarding long-term outcomes, AF was an independent predictor for death (HRR 1.46; 95% CI 1.39-1.52, p<0.001), ischemic stroke (HRR 1.63; 95% CI 1.44-1.85) and amputation (HRR 1.14; 95% CI 1.07-1.21).
  
  
  CONCLUSIONS
  Presence of AF in patients admitted for PAD and CLI is associated with worse in-hospital and long-term outcome than in patients without AF. This effect was independent of numerous other comorbidities and stage of vascular disease.
authors.affiliation: Division of Clinical and Experimental Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Germany. Electronic address: wasmerk@ukmuenster.de.
authors.forename: Kristina
authors.initials: K
authors.lastname: Wasmer
authors.affiliation: Department of New Public Health, School of Human Sciences, Osnabrück University, Osnabrück, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Unrath
authors.affiliation: Division of Clinical and Experimental Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Köbe
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Germany.
authors.forename: Nasser M
authors.initials: NM
authors.lastname: Malyar
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Freisinger
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Meyborg
authors.affiliation: Division of Clinical and Experimental Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.affiliation: Division of Clinical and Experimental Electrophysiology, Department of Cardiovascular Medicine, University Hospital Münster, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.affiliation: Division of Vascular Medicine, Department of Cardiovascular Medicine, University Hospital Münster, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors
keywords: Atrial fibrillation; Outcome; Peripheral artery disease