Acute Care Outcomes and 30-Day Readmission Among Patients With Peripheral Artery Disease Hospitalized for Acute Heart Failure: A Retrospective Cohort Study

Authors

• Nameer Ascandar, HCA HealthcareFollow
• Chidambaram Chinniah, HCA HealthcareFollow
• Jahanzaib Ekram, HCA HealthcareFollow
• Sai Santosh Sreenivasan, HCA HealthcareFollow
• Brett Milford
• Rias Ali, HCA HealthcareFollow

Division

West Florida

Hospital

Doctors Hospital of Sarasota

Document Type

Manuscript

Publication Date

4-7-2026

Keywords

critical limb ischemia, heart failure, peripheral artery disease

Disciplines

Cardiology | Cardiovascular Diseases | Internal Medicine | Medicine and Health Sciences

Abstract

Peripheral artery disease (PAD) commonly coexists with acute heart failure (HF), yet the short-term prognostic implications of PAD severity during HF hospitalization are uncertain. Using nationally representative data, we queried all adult (≥18 years) index admissions with a primary diagnosis of acute HF. Cohorts were stratified into 3 groups according to PAD presence and severity using the Rutherford classification. Patients with Rutherford categories 0-3 were classified as PAD, those with categories 4-6 as critical limb ischemia (CLI), and all remaining cohorts without PAD comprised the non-PAD group. Compared with non-PAD, PAD was associated with higher adjusted odds of mortality [adjusted odds ratio (aOR), 1.10; 95% confidence interval (CI), 1.03-1.18], acute kidney injury (AKI) (aOR, 1.15; 95% CI, 1.12-1.18), cardiogenic shock (aOR, 1.13; 95% CI, 1.03-1.23), nonhome discharge (aOR, 1.15; 95% CI, 1.11-1.18), all-cause 30-day readmission (aOR, 1.21; 95% CI, 1.18-1.25), and HF readmission (aOR, 1.28; 95% CI, 1.21-1.35), as well as modestly longer length of stay by +0.39 days and higher hospitalization costs by +$500. CLI conferred markedly higher odds of mortality (aOR, 2.77; 95% CI, 2.06-3.73), cardiogenic shock (aOR, 2.31; 95% CI, 1.65-3.24), AKI (aOR, 1.41; 95% CI, 1.21-1.65), AKI requiring dialysis (aOR, 4.55; 95% CI, 2.19-9.47), and all-cause 30-day readmission (aOR, 1.59; 95% CI, 1.33-1.90), with substantially greater length of stay by +5.07 days and hospitalization costs by +$19,700. In acute HF admissions, increasing PAD severity is linked with progressively worse in-hospital outcomes and greater resource utilization, supporting early multidisciplinary inpatient management and intensified postdischarge planning for patients with PAD, particularly CLI.

Publisher or Conference

Cardiology in Review

Recommended Citation

Ascandar N, Chinniah C, Ekram J, Sreenivasan SS, Milford B, Ali R. Acute Care Outcomes and 30-Day Readmission Among Patients With Peripheral Artery Disease Hospitalized for Acute Heart Failure: A Retrospective Cohort Study. Cardiol Rev. doi:10.1097/CRD.0000000000001266