Prognostic impact of heart failure phenotype on survival after endovascular therapy for peripheral artery disease: Insights from the multicenter retrospective SETers study

Objective Peripheral artery disease (PAD) is frequently complicated by heart failure (HF), yet the prognostic impact of HF and its phenotypes in patients undergoing endovascular therapy (EVT) remains poorly defined. This study evaluated the 3-year mortality associated with HF and compared outcomes between HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). Design and Methods This multicenter retrospective study included 1,585 patients who underwent EVT for symptomatic PAD between 2018 and 2020. Patients were stratified into non-HF (n = 946) and HF (n = 639) groups; HF was further categorized into HFpEF (EF ≥50%) and HFrEF (EF <40%). The primary outcome was all-cause mortality at 3 years. Results During the 3-year follow-up, all-cause mortality was significantly higher in patients with HF than in those without HF (26.8% vs 8.1%, log-rank p < 0.001). In the overall population, HFrEF was independently associated with increased mortality compared with non-HF patients (adjusted HR 2.07, 95% CI 1.13–3.76; p=0.017), whereas HFpEF was not. Among patients with HF, HFrEF was associated with higher mortality than HFpEF (38.5% vs 22.8%, p=0.009), and this remained significant after multivariable adjustment (adjusted HR 1.81, 95% CI 1.16–2.82; p=0.009). In multivariable analysis, age ≥75 years, chronic limb-threatening ischemia, hemodialysis, serum albumin <3.0 g/dL, and HFrEF were independently associated with all-cause mortality. Conclusion HF phenotype provides important prognostic information in EVT-treated PAD patients. HFrEF was associated with the highest mortality risk, particularly in patients with CLTI.