Atrial Fibrillation in Peripheral Arterial Disease Increases MACE Risk, with Viet Le, DMSc, PA-C

Atrial fibrillation (AF) has displayed extreme prevalence in patients with peripheral arterial disease (PAD), accompanied by a doubled rate of major adverse cardiovascular events (MACEs), according to a recent study.1

These data were presented by Viet Le, DMSc, PA-C, associate professor of research and a preventive cardiology PA at Intermountain Health, at the American Heart Association’s Scientific Sessions 2025 in New Orleans, Louisiana.1

The editorial team at HCPLive sat down with Le to discuss the implications of these data, highlighting what needs to be done for patients in light of this significantly increased risk.

“It turns out that if you have PAD and AF, it increases your risk for heart failure. It is excessively high,” Le told HCPLive. “I mean, it nearly doubles the risk for people who have PAD and AF. And this was at baseline, so we weren’t looking at incidents.”

Previous analyses have highlighted the potential prognostic role of AF in patients with PAD, connecting the disease to an increased mortality and MACE risk. In particular, a 2017 review of six prospective studies, including data from almost 15,000 patients, found a significant association between AF and mortality rates, as well as a substantial impact of AF on MACE risk.2

For this study, Intermountain Health collected data on patients from January 2006 to December 2021. This was used by Le and colleagues to identify adult patients with a first-time PAD diagnosis who had a second visit within 18 months. MACE was defined as a composite of all-cause death, myocardial infarction, heart failure (HF) hospitalization, stroke, and unstable angina hospitalization.1

A total of 7613 patients were included in the analysis; of these, 98.8% had symptomatic PAD. After multivariable Cox proportional hazard regression analyses, Le and colleagues found that a total of 22.6% (n = 1723) of patients had prior AF. Of the total number of patients, roughly 25% of patients with PAD and AF had a MACE within 1 year and 46% within 3 years. By comparison, 12% of patients without AF had a MACE at 1 year, and 25% had a MACE at 3 years.1

Additionally, investigators found death and HF hospitalization as the 2 greatest contributors to MACE. After adjustment for differences in baseline and guideline-directed medical therapy, patients with AF were found to be 21% more likely to have MACE and were 1.4-1.5 times more likely to be hospitalized for HF.1

Ultimately, the team determined that MACE event rates were doubled when AF was present, and HF hospitalization was a major contributor to this risk. The team called for assessment for AF in patients with PAD, and if the condition is found, aggressive preventative treatment for MACE should be implemented.1

Le also discussed next steps for both clinicians and investigators, spotlighting the variety of potential treatments and their limited use in this underserved patient population.

“It’s not small to have a heart attack, but we can revascularize those individuals, we can give stents, et cetera,” Le said. “But when you lose an extremity, that is super disabling, and it leads to so many more diseases. We need to do better for that population – there are treatments right now that can reduce the risk of amputation and disabling outcomes of PAD. We’ve waited too long."

References

1. Le V, Bair T, May H, et al. Prevalence of atrial fibrillation increases major adverse cardiovascular events, particularly heart failure hospitalization, in patients with peripheral arterial disease. Presented at the American Heart Association’s Scientific Sessions 2025. New Orleans, Louisiana. November 8-10, 2025.

2. Vrsalović M, Presečki AV. Atrial fibrillation and risk of cardiovascular events and mortality in patients with symptomatic peripheral artery disease: A meta-analysis of prospective studies. Clin Cardiol. 2017;40(12):1231-1235. doi:10.1002/clc.22813