Published Online
on October 27, 2009

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Original Article

Effects of Peripheral Arterial Disease on Outcomes in Advanced Chronic Systolic Heart Failure: A Propensity-Matched Study

Mustafa I. Ahmed¹; Wilbert S. Aronow²; Michael H. Criqui³; Inmaculada Aban¹; Thomas E. Love⁴; Eric J. Eichhorn⁵ and Ali Ahmed^6,7

¹ University of Alabama at Birmingham, Birmingham, AL;
² New York Medical College, Valhalla, NY;
³ University of California at San Diego, San Diego, La Jolla, CA;
⁴ Case Western Reserve University, Cleveland, OH;
⁵ Cardiopulmonary Research Science and Technology Institute, Dallas, TX;
⁶ University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, AL

^* Corresponding author; email: aahmed{at}uab.edu

Background—The effect of peripheral arterial disease (PAD) on outcomes in patients with chronic heart failure (HF) has not been examined in propensity-matched studies.

Methods and Results—Of the 2689 patients with advanced chronic systolic HF in the Beta-Blocker Evaluation of Survival Trial, 441 had a history of PAD. Propensity scores for a history of PAD, calculated for each patient using a multivariable logistic regression model, were used to assemble a matched cohort of 299 and 1015 patients respectively with and without PAD who were well-balanced on 65 measured baseline characteristics. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between PAD and outcomes during 4.1 years of follow-up. Patients had a mean age of 63 (±11) years, 19% were women and 19% were African Americans. All-cause mortality occurred in 43% and 33% of patients with and without a history of PAD, respectively (HR when PAD was compared with no-PAD, 1.40; 95% CI, 1.14–1.72; p=0.001). All-cause hospitalization occurred in 78% and 63% of patients with and without PAD, respectively (HR when PAD was compared with no-PAD, 1.36; 95% CI, 1.16–1.58; p<0.0001). PAD-associated HRs for cardiovascular mortality, HF mortality and HF hospitalization were respectively 1.31 (95% CI, 1.04–1.63; p=0.019), 1.40 (95% CI, 0.97–2.02; p=0.076) and 1.05 (95% CI, 0.86–1.29; p=0.635).

Conclusion—In a well-balanced propensity-matched population of chronic systolic HF patients, a history of PAD was independently associated with increased mortality and hospitalization.

Key Words: heart failure • hospitalization • mortality • peripheral artery disease