New-onset versus prior history of atrial fibrillation: Outcomes from the AFFIRM trial

Abdulla A. Damluji, Mohammed S. Al-Damluji, George R. Marzouka, James O. Coffey, Juan Viles Gonzalez, Mauricio G Cohen, Mauro Moscucci, Robert J Myerburg, Raul Mitrani

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Abstract

Background There are limited data on prognosis and outcomes of patients with new-onset atrial fibrillation (AF) compared with those with a prior history of AF. Methods and results We conducted a comparison of these 2 groups in the AFFIRM trial. New-onset AF was the qualifying arrhythmia in 1,391 patients (34%). Compared with patients with prior history of AF, patients with new-onset AF were more likely to have a history of heart failure. There was no mortality difference between rate control (RaC) and rhythm control (RhC) among patients with new-onset AF (17% vs 20%, P =.152). In the univariate model, new-onset AF was associated with increased risk of mortality compared with history of prior AF (RaC unadjusted hazard ratio [HR] 1.36 [P =.010], RhC unadjusted HR 1.39 [P =.003]). However, after multivariate adjustments, new-onset AF did not carry an increased risk of mortality (RaC adjusted HR 1.14 [P =.370], RhC adjusted HR 1.16 [P =.248]). Subjects with new-onset AF randomized to the RhC arm were more likely to remain in normal sinus rhythm at follow-up (adjusted HR 0.79, P =.012) compared with patients with prior history of AF. Conclusions In a multivariable analysis adjusting for confounders, new-onset AF was not associated with increased mortality compared with prior history of AF regardless of the treatment strategy. Patients with new-onset AF treated with the rhythm control strategy were more likely to remain in normal sinus rhythm on follow-up.

Original languageEnglish (US)
Pages (from-to)156-163.e1
JournalAmerican Heart Journal
Volume170
Issue number1
DOIs
StatePublished - Jul 1 2015

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Atrial Fibrillation
Safety Management
Mortality
Cardiac Arrhythmias
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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New-onset versus prior history of atrial fibrillation : Outcomes from the AFFIRM trial. / Damluji, Abdulla A.; Al-Damluji, Mohammed S.; Marzouka, George R.; Coffey, James O.; Viles Gonzalez, Juan; Cohen, Mauricio G; Moscucci, Mauro; Myerburg, Robert J; Mitrani, Raul.

In: American Heart Journal, Vol. 170, No. 1, 01.07.2015, p. 156-163.e1.

Research output: Contribution to journalArticle

Damluji, AA, Al-Damluji, MS, Marzouka, GR, Coffey, JO, Viles Gonzalez, J, Cohen, MG, Moscucci, M, Myerburg, RJ & Mitrani, R 2015, 'New-onset versus prior history of atrial fibrillation: Outcomes from the AFFIRM trial', American Heart Journal, vol. 170, no. 1, pp. 156-163.e1. https://doi.org/10.1016/j.ahj.2015.04.020
Damluji AA, Al-Damluji MS, Marzouka GR, Coffey JO, Viles Gonzalez J, Cohen MG et al. New-onset versus prior history of atrial fibrillation: Outcomes from the AFFIRM trial. American Heart Journal. 2015 Jul 1;170(1):156-163.e1. https://doi.org/10.1016/j.ahj.2015.04.020
Damluji, Abdulla A. ; Al-Damluji, Mohammed S. ; Marzouka, George R. ; Coffey, James O. ; Viles Gonzalez, Juan ; Cohen, Mauricio G ; Moscucci, Mauro ; Myerburg, Robert J ; Mitrani, Raul. / New-onset versus prior history of atrial fibrillation : Outcomes from the AFFIRM trial. In: American Heart Journal. 2015 ; Vol. 170, No. 1. pp. 156-163.e1.
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AU - Marzouka, George R.

AU - Coffey, James O.

AU - Viles Gonzalez, Juan

AU - Cohen, Mauricio G

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AU - Mitrani, Raul

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N2 - Background There are limited data on prognosis and outcomes of patients with new-onset atrial fibrillation (AF) compared with those with a prior history of AF. Methods and results We conducted a comparison of these 2 groups in the AFFIRM trial. New-onset AF was the qualifying arrhythmia in 1,391 patients (34%). Compared with patients with prior history of AF, patients with new-onset AF were more likely to have a history of heart failure. There was no mortality difference between rate control (RaC) and rhythm control (RhC) among patients with new-onset AF (17% vs 20%, P =.152). In the univariate model, new-onset AF was associated with increased risk of mortality compared with history of prior AF (RaC unadjusted hazard ratio [HR] 1.36 [P =.010], RhC unadjusted HR 1.39 [P =.003]). However, after multivariate adjustments, new-onset AF did not carry an increased risk of mortality (RaC adjusted HR 1.14 [P =.370], RhC adjusted HR 1.16 [P =.248]). Subjects with new-onset AF randomized to the RhC arm were more likely to remain in normal sinus rhythm at follow-up (adjusted HR 0.79, P =.012) compared with patients with prior history of AF. Conclusions In a multivariable analysis adjusting for confounders, new-onset AF was not associated with increased mortality compared with prior history of AF regardless of the treatment strategy. Patients with new-onset AF treated with the rhythm control strategy were more likely to remain in normal sinus rhythm on follow-up.

AB - Background There are limited data on prognosis and outcomes of patients with new-onset atrial fibrillation (AF) compared with those with a prior history of AF. Methods and results We conducted a comparison of these 2 groups in the AFFIRM trial. New-onset AF was the qualifying arrhythmia in 1,391 patients (34%). Compared with patients with prior history of AF, patients with new-onset AF were more likely to have a history of heart failure. There was no mortality difference between rate control (RaC) and rhythm control (RhC) among patients with new-onset AF (17% vs 20%, P =.152). In the univariate model, new-onset AF was associated with increased risk of mortality compared with history of prior AF (RaC unadjusted hazard ratio [HR] 1.36 [P =.010], RhC unadjusted HR 1.39 [P =.003]). However, after multivariate adjustments, new-onset AF did not carry an increased risk of mortality (RaC adjusted HR 1.14 [P =.370], RhC adjusted HR 1.16 [P =.248]). Subjects with new-onset AF randomized to the RhC arm were more likely to remain in normal sinus rhythm at follow-up (adjusted HR 0.79, P =.012) compared with patients with prior history of AF. Conclusions In a multivariable analysis adjusting for confounders, new-onset AF was not associated with increased mortality compared with prior history of AF regardless of the treatment strategy. Patients with new-onset AF treated with the rhythm control strategy were more likely to remain in normal sinus rhythm on follow-up.

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