Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID
Background Peripheral artery disease (PAD) and heart failure (HF) are each independently associated with poor outcomes. Risk factors associated with new‐onset HF in patients with primary PAD are unknown. Furthermore, how the presence of HF is associated with outcomes in patients with PAD is unknown....
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018684 |
| _version_ | 1819182718990155776 |
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| author | Marc D. Samsky Anne Hellkamp William R. Hiatt F. Gerry R. Fowkes Iris Baumgartner Jeffrey S. Berger Brian G. Katona Kenneth W. Mahaffey Lars Norgren Juuso I. Blomster Frank W. Rockhold Adam D. DeVore Manesh R. Patel W. Schuyler Jones |
| author_facet | Marc D. Samsky Anne Hellkamp William R. Hiatt F. Gerry R. Fowkes Iris Baumgartner Jeffrey S. Berger Brian G. Katona Kenneth W. Mahaffey Lars Norgren Juuso I. Blomster Frank W. Rockhold Adam D. DeVore Manesh R. Patel W. Schuyler Jones |
| author_sort | Marc D. Samsky |
| collection | DOAJ |
| description | Background Peripheral artery disease (PAD) and heart failure (HF) are each independently associated with poor outcomes. Risk factors associated with new‐onset HF in patients with primary PAD are unknown. Furthermore, how the presence of HF is associated with outcomes in patients with PAD is unknown. Methods and Results This analysis examined risk relationships of HF on outcomes in patients with symptomatic PAD randomized to ticagrelor or clopidogrel as part of the EUCLID (Examining Use of Ticagrelor in Peripheral Arterial Disease) trial. Patients were stratified based on presence of HF at enrollment. Cox models were used to determine the association of HF with outcomes. A separate Cox model was used to identify risk factors associated with development of HF during follow‐up. Patients with PAD and HF had over twice the rate of concomitant coronary artery disease as those without HF. Patients with PAD and HF had significantly increased risk of major adverse cardiovascular events (hazard ratio [HR], 1.31; 95% CI, 1.13–1.51) and all‐cause mortality (HR, 1.39; 95% CI, 1.19–1.63). In patients with PAD, the presence of HF was associated with significantly less bleeding (HR, 0.65; 95% CI, 0.45–0.96). Characteristics associated with HF development included age ≥66 (HR, 1.29; 95% CI, 1.18–1.40 per 5 years), diabetes mellitus (HR, 1.85; 95% CI, 1.41–2.43), and weight (bidirectionally associated, ≥76 kg, HR, 0.77; 95% CI, 0.64–0.93; <76 kg, HR, 1.12; 95% CI, 1.07–1.16). Conclusions Patients with PAD and HF have a high rate of coronary artery disease with a high risk for major adverse cardiovascular events and death. These data support the possible need for aggressive treatment of (recurrent) atherosclerotic disease in PAD, especially patients with HF. |
| first_indexed | 2024-12-22T22:50:35Z |
| format | Article |
| id | doaj.art-8443e47a670245ccb2104c004277aebe |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T22:50:35Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-8443e47a670245ccb2104c004277aebe2022-12-21T18:09:58ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-06-01101210.1161/JAHA.120.018684Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLIDMarc D. Samsky0Anne Hellkamp1William R. Hiatt2F. Gerry R. Fowkes3Iris Baumgartner4Jeffrey S. Berger5Brian G. Katona6Kenneth W. Mahaffey7Lars Norgren8Juuso I. Blomster9Frank W. Rockhold10Adam D. DeVore11Manesh R. Patel12W. Schuyler Jones13Duke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NCDuke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NCUniversity of Colorado School of Medicine and CPC Clinical Research Aurora COUsher Institute of Population Health Sciences and Informatics University of Edinburgh United KingdomSwiss Cardiovascular Centre, Inselspital Bern University HospitalUniversity of Bern SwitzerlandDepartments of Medicine and Surgery New York University School of Medicine New York NYAstraZeneca Gaithersburg Gaithersburg MDStanford Center for Clinical Research Stanford University School of Medicine Stanford CAFaculty of Medicine and Health Örebro University Örebro SwedenHeart Centre Turku University Hospital Turku FinlandDuke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NCDuke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NCDuke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NCDuke Heart Center Duke University Medical CenterDuke Clinical Research InstituteDuke University School of Medicine Durham NCBackground Peripheral artery disease (PAD) and heart failure (HF) are each independently associated with poor outcomes. Risk factors associated with new‐onset HF in patients with primary PAD are unknown. Furthermore, how the presence of HF is associated with outcomes in patients with PAD is unknown. Methods and Results This analysis examined risk relationships of HF on outcomes in patients with symptomatic PAD randomized to ticagrelor or clopidogrel as part of the EUCLID (Examining Use of Ticagrelor in Peripheral Arterial Disease) trial. Patients were stratified based on presence of HF at enrollment. Cox models were used to determine the association of HF with outcomes. A separate Cox model was used to identify risk factors associated with development of HF during follow‐up. Patients with PAD and HF had over twice the rate of concomitant coronary artery disease as those without HF. Patients with PAD and HF had significantly increased risk of major adverse cardiovascular events (hazard ratio [HR], 1.31; 95% CI, 1.13–1.51) and all‐cause mortality (HR, 1.39; 95% CI, 1.19–1.63). In patients with PAD, the presence of HF was associated with significantly less bleeding (HR, 0.65; 95% CI, 0.45–0.96). Characteristics associated with HF development included age ≥66 (HR, 1.29; 95% CI, 1.18–1.40 per 5 years), diabetes mellitus (HR, 1.85; 95% CI, 1.41–2.43), and weight (bidirectionally associated, ≥76 kg, HR, 0.77; 95% CI, 0.64–0.93; <76 kg, HR, 1.12; 95% CI, 1.07–1.16). Conclusions Patients with PAD and HF have a high rate of coronary artery disease with a high risk for major adverse cardiovascular events and death. These data support the possible need for aggressive treatment of (recurrent) atherosclerotic disease in PAD, especially patients with HF.https://www.ahajournals.org/doi/10.1161/JAHA.120.018684heart failureoutcomesperipheral artery disease |
| spellingShingle | Marc D. Samsky Anne Hellkamp William R. Hiatt F. Gerry R. Fowkes Iris Baumgartner Jeffrey S. Berger Brian G. Katona Kenneth W. Mahaffey Lars Norgren Juuso I. Blomster Frank W. Rockhold Adam D. DeVore Manesh R. Patel W. Schuyler Jones Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure outcomes peripheral artery disease |
| title | Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID |
| title_full | Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID |
| title_fullStr | Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID |
| title_full_unstemmed | Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID |
| title_short | Association of Heart Failure With Outcomes Among Patients With Peripheral Artery Disease: Insights From EUCLID |
| title_sort | association of heart failure with outcomes among patients with peripheral artery disease insights from euclid |
| topic | heart failure outcomes peripheral artery disease |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018684 |
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