Vascular disease, including peripheral artery disease, significant coronary artery disease, and aortic disease, is associated with an increased risk of atrial fibrillation (AF) and ischaemic stroke in patients with AF. This retrospective analysis published in Current Problems in Cardiology examined whether the presence of vascular disease influences outcomes in patients with AF. All AF patients were identified and categorized according to the presence or absence of vascular disease; three patients were excluded due to missing data.
A total of 8,962 patients were included, comprising 3,021 with vascular disease and 5,941 without, with a mean follow-up of 929 ± 1082 days. The primary outcome was a composite of death, thromboembolic events, and stroke. Secondary outcomes included all-cause mortality (ACM), stroke or systemic embolism (SSE), hemorrhagic stroke, ischemic stroke (IS), and major bleeding.
On univariate analysis, vascular disease was associated with higher risks of all-cause mortality (ACM) (HR, 1.728; 95% CI, 1.549–1.928), stroke or systemic embolism (SSE) (HR, 1.477; 95% CI, 1.274–1.714), ischaemic stroke (IS) (HR, 1.441; 95% CI, 1.202–1.727), major bleeding (HR, 1.488; 95% CI, 1.292–1.713), and the composite of death and SSE (HR, 1.643; 95% CI, 1.489–1.812).
After multivariable adjustment for components of the CHA₂DS₂VASc score, warfarin use, and antiplatelet therapy, the increased risks of ACM (HR, 1.460; 95% CI, 1.285–1.658), SSE (HR, 1.226; 95% CI, 1.030–1.458), and major bleeding (HR, 1.186; 95% CI, 1.005–1.400) remained statistically significant, whereas the risk of IS was no longer significant (HR, 1.187; 95% CI, 0.960–1.469). The risk of haemorrhagic stroke was lower among patients with vascular disease, although this difference was not statistically significant.
AF patients with coexisting vascular disease demonstrated higher risks of mortality, major bleeding, and thromboembolic events. Careful and holistic management of risk factors and treatment strategies may be warranted in this population.
