The impact of ethnicity and atrial fibrillation on epidemiology and outcomes of peripheral arterial disease

Vitalis, Antonios ORCID: 0000-0003-2915-3310 (2023). The impact of ethnicity and atrial fibrillation on epidemiology and outcomes of peripheral arterial disease. University of Birmingham. M.D.

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Abstract

Peripheral arterial disease (PAD) is a pandemic with increasing prevalence worldwide. There is evidence that epidemiology and natural history of PAD differ among different ethnic groups. In addition, there is increasing interest on the coexistence of PAD and atrial fibrillation (AF), which significantly increases the risk of adverse events, mainly mortality and stroke. This thesis aims to investigate the association between ethnicity, AF and PAD and its effect on epidemiology and outcomes.
In Chapter 2 a systematic review and meta-analysis of literature was performed to investigate ethnic differences in prevalence of PAD in the general population and in patients with diabetes. Black ethnicity was associated with significantly higher rates of PAD compared to White ethnicity in general population studies. On the other hand, Asians had significantly lower rates of PAD compared to Whites in general population and in diabetic population studies.
In Chapter 3, a retrospective study of Hospital Episode Statistics (HES) database was performed in order to compare the outcomes of femoral-popliteal bypass operations and femoral angioplasty/stenting procedures among patients of White, Asian and Black ethnicity, for a 10-year period between 01/01/2006 and 31/12/2015. Patients of Black ethnicity were at higher risk of limb loss in 2 years after open or endovascular femoropopliteal interventions. Asians had similar rates of limb loss compared to Whites but had higher 2-year mortality in the endovascular group.
Chapter 4 investigated the impact of AF on a cohort of patients with PAD. A retrospective analysis of primary care data from The Health Improvement Network (THIN) database was performed and a comparison of outcomes was made between patients with PAD and AF (cases) and patients with PAD and no AF (controls). AF was found to be a predictor of mortality, cerebrovascular events and development of heart failure in patients with PAD, but AF was not associated with development of ischaemic heart disease or limb loss.
Chapter 5 was an ancillary analysis of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial, investigating the impact of PAD on a cohort of patients with AF. A post-hoc analysis of the clinical trial dataset demonstrated that PAD was associated with higher mortality in patients with AF. In the subgroup of non-anticoagulated patients PAD was a strong predictor of stroke.

Type of Work:

Thesis (Doctorates > M.D.)

Award Type:

Doctorates > M.D.

Supervisor(s):