Impact of atrial fibrillation on heart failure-related events after endovascular therapy for peripheral artery disease

Atrial fibrillation (AF) is common in patients with peripheral artery disease (PAD) and is associated with adverse cardiovascular outcomes. However, its impact on heart failure (HF)-related events after endovascular therapy (EVT) remains unclear, particularly according to baseline HF status.We retrospectively analyzed a multicenter cohort of 1585 patients with symptomatic PAD undergoing EVT. Patients were stratified according to AF and baseline HF status. The primary outcome was HF-related events over a 3-year follow-up period. Kaplan-Meier analysis and Cox proportional hazards models were used. AF was associated with a higher risk of HF-related events. At 3 years, event-free survival was lower in patients with AF than in those without AF. In patients without baseline HF, event-free survival was significantly lower in those with AF (87.9 vs. 96.8%, log-rank p < 0.001). In contrast, in patients with established HF, the difference was attenuated (67.2 vs. 75.7%, log-rank p = 0.053). In stratified multivariable analysis, AF was strongly associated with HF-related events in patients without baseline HF (HR 4.03, 95% CI 1.85-8.78; p < 0.001), whereas this association was attenuated in those with baseline HF (HR 1.34, 95% CI 0.96-1.88; p = 0.085). A significant interaction was observed between AF and baseline HF status (p for interaction = 0.013). In patients with PAD undergoing EVT, AF was associated with HF-related events; however, its prognostic impact was significantly modified by baseline HF status, with a markedly stronger effect observed in patients without pre-existing HF.