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The Prognostic Value of Peripheral Artery Disease in Heart Failure: Insights from a Meta-analysis. BACKGROUND: Peripheral artery disease (PAD) is prevalent in individuals with heart failure (HF). We therefore performed a meta-analysis to assess the prognostic impact of PAD in HF patients. METHODS: A systematic search of PubMed and The Cochrane Library was conducted to identify publications from inception to May 2015. We also manually assessed the reference lists of relevant literature for more eligible citations. Only studies reporting the risk of PAD for prognostic endpoints in HF were included in our meta-analysis. RESULTS: The search strategy yielded eight studies comprising a total of 20,968 subjects, of whom 19.4% had a concurrent PAD. All-cause mortality in HF patients with PAD was profoundly higher than in those without this comorbidity (hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.25 to 1.49). Peripheral artery disease was also associated with significant increases in HF hospitalisation and cardiovascular mortality in individuals with HF (HR 1.15, 95% CI 1.01 to 1.32; HR 1.31, 95% CI 1.13 to 1.52, respectively). Subgroup and sensitivity analyses supported the positive relationship between PAD and HF. CONCLUSIONS: Peripheral artery disease is associated with a worse overall prognosis in HF patients, which highlights the need to increase focus on PAD as an important comorbidity in patients with HF.