%0 Journal Article
%@ 1861-0684
%A Ferreira, João Pedro
%A Cleland, John G.
%A Lam, Carolyn S.P.
%A Anker, Stefan D.
%A Mehra, Mandeep R.
%A van Veldhuisen, Dirk J.
%A Byra, William M.
%A LaPolice, David A.
%A Greenberg, Barry
%A Zannad, Faiez
%D 2022
%F enlighten:245458
%I Springer
%J Clinical Research in Cardiology
%N 1
%P 50-59
%R 10.1007/s00392-021-01891-2
%T New-onset atrial fibrillation in patients with worsening heart failure and coronary artery disease: an analysis from the COMMANDER-HF trial
%U https://eprints.gla.ac.uk/245458/
%V 111
%X Background:   Atrial fibrillation (AF) in the presence of heart failure (HF) is associated with poor outcomes including a high-risk of stroke and other thromboembolic events. Identifying patients without AF who are at high-risk of developing this arrhythmia has important clinical implications.    Aims:   To develop a risk score to identify HF patients at high risk of developing AF.    Methods:   The COMMANDER-HF trial enrolled 5022 patients with HF and a LVEF ≤ 40%, history of coronary artery disease, and absence of AF at baseline (confirmed with an electrocardiogram). Patients were randomized to either rivaroxaban (2.5 mg bid) or placebo. New-onset AF was confirmed by the investigator at study visits.    Results  241 (4.8%) patients developed AF during the follow-up (median 21 months). Older age (≥ 65 years), LVEF < 35%, history of PCI or CABG, White race, SBP < 110 mmHg, and higher BMI (≥ 25 kg/m2) were independently associated with risk of new-onset AF, whereas the use of DAPT was associated with a lower risk of new-onset AF. We then built a risk score from these variables (with good accuracy C-index = 0.71) and calibration across observed and predicted tertiles of risk. New-onset AF events rates increased steeply by increasing tertiles of the risk-score. Compared to tertile 1, the risk of new-onset AF was 2.5-fold higher in tertile 2, and 6.3-fold higher in tertile 3. Rivaroxaban had no effect in reducing new-onset AF. In time-updated models, new-onset AF was associated with a higher risk of subsequent all-cause death: HR (95%CI) 1.38 (1.11–1.73).    Conclusions:   A well-calibrated risk-score identified patients at risk of new-onset AF in the COMMANDER-HF trial. Patients who developed AF had a higher risk of subsequent death.
%Z JF and FZ are supported by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second “Investissements d’Avenir” program (reference: ANR-15-RHUS-0004), and by the French PIA project “Lorraine Université d’Excellence” (reference: ANR-15-IDEX-04-LUE). The COMMANDER-HF trial was supported by Janssen Research and Development.