In a multiethnic cohort of 388 patients admitted with symptomatic peripheral artery disease, atrial fibrillation was associated with emergency admission and increased mortality. Despite a greater prevalence of hypertension and diabetes in Afro-Caribbeans and diabetes in Indo-Asians, no significant differences were found in atrial fibrillation prevalence or mortality among different ethnic groups. Patients with symptomatic peripheral artery disease and atrial fibrillation should be regarded as "high risk" and managed with optimal medical therapy, including appropriate thromboprophylaxis and close follow-up.