School of Medicine Seth GS Medical College Mumbai India.
Division of Cardiology University of North Carolina School of Medicine Chapel Hill NC.
J Am Heart Assoc. 2020 Nov 3;9(21):e017174. doi: 10.1161/JAHA.120.017174. Epub 2020 Oct 26.
Background Peripheral artery disease (PAD) is both a common comorbidity and a contributing factor to heart failure. Whether PAD is associated with hospitalization for recurrent decompensation among patients with established heart failure is uncertain. Methods and Results Since 2005, the ARIC (Atherosclerosis Risk in Communities) study has conducted active surveillance of hospitalized acute decompensated heart failure (ADHF), with events verified by physician review. From 2005 to 2016, 1481 patients were hospitalized with ADHF and discharged alive (mean age, 78 years; 69% White). Of these, 207 (14%) had diagnosis of PAD. Those with PAD were more often men (55% versus 44%) and smokers (17% versus 8%), with a greater prevalence of coronary artery disease (72% versus 52%). Patients with PAD had an increased risk of at least 1 ADHF readmission, both within 30 days (11% versus 7%) and 1 year (39% versus 28%) of discharge from the index hospitalization. After adjustments, PAD was associated with twice the hazard of ADHF readmission within 30 days (HR, 2.02; 95% CI, 1.14-3.60) and a 60% higher hazard of ADHF readmission within 1 year (HR, 1.60; 95% CI, 1.25-2.05). The 1-year hazard of ADHF readmission associated with PAD was stronger with heart failure with reduced ejection fraction (HR, 2.01; 95% CI, 1.29-3.13) than preserved ejection fraction (HR, 1.04; 95% CI, 0.69-1.56); for interaction=0.05. Conclusions Patients with ADHF and concomitant PAD have a higher likelihood of ADHF readmission. Strategies to prevent ADHF readmissions in this high-risk group are warranted.
外周动脉疾病（PAD）既是常见的合并症，也是心力衰竭的促成因素。在已确诊心力衰竭的患者中，PAD 是否与复发性失代偿住院有关尚不确定。
自 2005 年以来，ARIC（社区动脉粥样硬化风险）研究一直对住院急性失代偿性心力衰竭（ADHF）进行主动监测，通过医生审查来验证事件。2005 年至 2016 年期间，有 1481 名患者因 ADHF 住院并存活出院（平均年龄为 78 岁；69%为白人）。其中，207 人（14%）患有 PAD。PAD 患者更多为男性（55%比 44%）和吸烟者（17%比 8%），冠心病的患病率更高（72%比 52%）。PAD 患者至少有 1 次 ADHF 再入院的风险增加，包括出院后 30 天内（11%比 7%）和 1 年内（39%比 28%）。经调整后，PAD 与 30 天内 ADHF 再入院的风险增加两倍相关（HR，2.02；95%CI，1.14-3.60），1 年内 ADHF 再入院的风险增加 60%（HR，1.60；95%CI，1.25-2.05）。与 PAD 相关的 1 年内 ADHF 再入院风险在射血分数降低的心力衰竭（HR，2.01；95%CI，1.29-3.13）中比射血分数保留的心力衰竭（HR，1.04；95%CI，0.69-1.56）中更强；交互检验=0.05。
患有 ADHF 合并 PAD 的患者 ADHF 再入院的可能性更高。需要采取策略来预防这一高危人群的 ADHF 再入院。
