Prevalence of Low Ankle-brachial Index in Patients With Atrial Fibrillation

Objectives: This study sought to explore the prevalence of Ankle/Brachial Index (ABI) 0.90 in patients with nonvalvular atrial fibrillation (AF) and its contribution to overall prevalence of cardiovascular disease, as assessed by CHA2DS2-VASc score. Background: In AF patients, cardiovascular disease, including a history of peripheral artery disease (PAD), is a component of CHA2DS2-VASc score. ABI 0.90 is a marker of PAD and provides independent prediction of cardiovascular events. Prevalence of ABI 0.90 in large AF population is still unknown. Methods: The Atrial fibrillation Registry for ABI Prevalence AssessmentCollaborative Italian Study (ARAPACIS) is a prospective multicenter study. ABI was measured in 2,027 consecutive AF patients referred to 136 centers of the Italian Society of Internal Medicine. Results: 428 (21%) patients had ABI 0.90 and 1,381 had ABI 0.90-1.39 (69%); whilst 204 patients (10%) had ABI 1.40. Logistic regression analysis demonstrated that ABI 0.90 was significantly associated with smoking [OR, 2.01 (95% CI, 1.49-2.71)], diabetes [OR, 1.99 (1.55-2.55)], age 65-74 [OR, 2.08 (1.39-3.10)], age 75 [OR, 3.00 (2.04-4.42)], and history of TIA/stroke [OR, 1.66 (1.21 -2.28)]. A history of coronary and peripheral artery disease was detected in 17.3% of patients; but the inclusion of ABI 0.90 in the definition of cardiovascular disease yielded a total prevalence of 33% and enhanced cardiovascular disease prevalence in each class of the CHA2DS2-VASc score. Conclusions: One fifth of AF patients have an ABI 0.90 and are at potentially higher risk of cardiovascular events. ABI enhances vascular disease prevalence and could be included in the AF cardiovascular risk assessment.