Peripheral arterial disease and chronic heart failure: a dangerous mix

Abstract

Chronic heart failure (CHF) is associated with a high comorbidity burden, adverse impact on quality of life and high health care utilisation. Peripheral arterial disease (PAD) and CHF share many risk, pathophysiological and prognostic features, and each has been associated with increased morbidity and mortality. PAD often goes undetected, and yet in spite of the availability of screening tools, this is not commonly considered in CHF care. A review of the electronic databases Medline, CINAHL and Cochrane CENTRAL was undertaken using the MeSH terms peripheral arterial disease, peripheral vascular disease, intermittent claudication and heart failure to identify studies examining the prevalence and clinical outcomes of coexisting PAD in patients with CHF. Five studies were identified. There are limited data describing the impact of PAD on CHF outcomes. As PAD may contribute to decreased capacity to exercise and other self-care behaviours, identifying those at risk and providing appropriate therapy are important. Based on this review, patients who are smokers and those with diagnosed coronary heart disease and diabetes should be targeted for the screening of PAD.

The CHA2DS2‐VASc score as a predictor of high mortality in hospitalized heart failure patients

“…HF patients with ischemic etiology have higher mortality 1, 2. A few studies have revealed that HF patients with peripheral artery disease had poor prognosis 28, 29. On the other hand, female is associated with a decreased mortality 1, 2…”

Relation of the Ankle Brachial Index to Left Ventricular Ejection Fraction in Patients Without Coronary Artery Disease

“…In a meta-analysis of 11,304 patients with PAD, Anand et al [23] found that the prevalence of heart failure in patients with PAD was 7.9%, which was greater than the 4.1% expected from NHANES data. Thus, the prevalence of PAD is nearly doubled in the setting of heart failure, and PAD is associated with greater functional impairment and worse prognosis [23,24]. Moreover, analysis of atherosclerosis risk in community data found that low ABI values were predictive of incident heart failure events over 17 year follow-up [25].…”

Impact of Peripheral Artery Disease on Prognosis in Hospitalized Heart Failure Patients

“…5-7 This study adds to the current literature, and shows that PAD correlates with a more severe type of atherosclerosis even in HF. 5-7, 12 For treatment of patients with HF with PAD, appropriate comprehensive management including smoking cessation, diabetes control, and exercise training 35 following recent guidelines 5-7 is more important than usual, and may lead to improved prognosis of HF and PAD. Further investigation is needed to establish whether revascularization including peripheral percutaneous intervention 36 and surgery improves the prognosis of HF and PAD.…”