Because risk factors for heart failure (HF) cluster in persons with peripheral artery disease (PAD), the authors conducted a meta-analysis to examine the prevalence of HF in individuals with PAD. MEDLINE searches were performed to review all PAD clinical trials (1966–2003). Expected control population prevalence rates for HF were derived from the National Health and Nutrition Examination Survey (NHANES) database. In total, 11,304 patients were evaluated. The average age of the patients was 67±5 years. The prevalence of HF in patients with PAD was 7.9% (range, 5.3%–13.9%) compared with an expected prevalence of 4.1%(range, 3.7–4.5%). The relative risk for increased HF prevalence among those with PAD was 1.9 (range, 1.35–3.10; P<.001). Thirteen (range, 7–19) PAD patients needed to be screened to detect 1 case of HF. The presence of PAD is associated with a 2-fold increase in the prevalence of HF. The use of PAD as a risk marker for underlying HF may enhance the effectiveness of screening criteria for HF detection.