Acute Care Outcomes and 30-Day Readmission Among Patients With Peripheral Artery Disease Hospitalized for Acute Heart Failure: A Retrospective Cohort Study

Peripheral artery disease (PAD) commonly coexists with acute heart failure (HF), yet the short-term prognostic implications of PAD severity during HF hospitalization are uncertain. Using nationally representative data, we queried all adult (≥18 years) index admissions with a primary diagnosis of acute HF. Cohorts were stratified into 3 groups according to PAD presence and severity using the Rutherford classification. Patients with Rutherford categories 0-3 were classified as PAD, those with categories 4-6 as critical limb ischemia (CLI), and all remaining cohorts without PAD comprised the non-PAD group. Compared with non-PAD, PAD was associated with higher adjusted odds of mortality [adjusted odds ratio (aOR), 1.10; 95% confidence interval (CI), 1.03-1.18], acute kidney injury (AKI) (aOR, 1.15; 95% CI, 1.12-1.18), cardiogenic shock (aOR, 1.13; 95% CI, 1.03-1.23), nonhome discharge (aOR, 1.15; 95% CI, 1.11-1.18), all-cause 30-day readmission (aOR, 1.21; 95% CI, 1.18-1.25), and HF readmission (aOR, 1.28; 95% CI, 1.21-1.35), as well as modestly longer length of stay by +0.39 days and higher hospitalization costs by +$500. CLI conferred markedly higher odds of mortality (aOR, 2.77; 95% CI, 2.06-3.73), cardiogenic shock (aOR, 2.31; 95% CI, 1.65-3.24), AKI (aOR, 1.41; 95% CI, 1.21-1.65), AKI requiring dialysis (aOR, 4.55; 95% CI, 2.19-9.47), and all-cause 30-day readmission (aOR, 1.59; 95% CI, 1.33-1.90), with substantially greater length of stay by +5.07 days and hospitalization costs by +$19,700. In acute HF admissions, increasing PAD severity is linked with progressively worse in-hospital outcomes and greater resource utilization, supporting early multidisciplinary inpatient management and intensified postdischarge planning for patients with PAD, particularly CLI.