PAD with Acute Decompensated Heart Failure Means Greater Readmission Risk

Patients with acute decompensated heart failure and concomitant peripheral artery disease (PAD) have a higher burden of cardiovascular comorbidities and acute decompensated heart failure readmission, a new study suggests.

“PAD is both a common comorbidity and a contributing factor to heart failure,” the authors wrote. “Whether PAD is associated with hospitalization for recurrent decompensation among patients with established heart failure is uncertain.”

The Atherosclerosis Risk in Communities (ARIC) study included 1,418 patients hospitalized with acute decompensated heart failure between 2005 and 2016 (mean age, 78 years; 69% white). About 14% of those patients (n=207) had a diagnosis of PAD (and were more often men, smokers, with a greater prevalence of coronary artery disease). Chronic obstructive pulmonary disease was also more prevalent with PAD, as was a history of myocardial infarction and history of stroke or transient ischemic attack. The maximum number of recurrent acute decompensated heart failure readmissions per patient within 30 days of hospital discharge ranged between zero and two for both groups of patients, but the likelihood of being admitted at least once was disproportionately higher in the PAD group. PAD was linked with a higher likelihood of 30-day readmission for acute decompensated heart failure after adjustment for demographics and comorbidities.

“Patients with acute decompensated heart failure and concomitant PAD have a greater cardiovascular comorbidity burden and higher likelihood of acute decompensated heart failure readmission,” the researchers concluded. “The association is stronger among patients with heart failure with reduced ejection fraction, who may represent a high‐risk group suitable for targeted intervention.”

The authors continued with potential clinical implications of the results.

“Our findings contribute to understanding the association of PAD with acute decompensated heart failure readmission in a population‐based cohort encompassing four geographic regions of the United States,” they wrote. “Targeted interventions or secondary preventive measures combined with exercise therapy may help reduce readmission for acute decompensated heart failure in patients with coexisting peripheral artery disease.”

The study was published in the Journal of the American Heart Association.