title: New-onset versus prior history of atrial fibrillation: Outcomes from the AFFIRM trial.
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.
  
  
  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.
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Abdulla A
authors.initials: AA
authors.lastname: Damluji
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Mohammed S
authors.initials: MS
authors.lastname: Al-Damluji
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: George R
authors.initials: GR
authors.lastname: Marzouka
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: James O
authors.initials: JO
authors.lastname: Coffey
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Viles-Gonzalez
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Mauro
authors.initials: M
authors.lastname: Moscucci
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Myerburg
authors.affiliation: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL. Electronic address: RMitrani@med.miami.edu.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Mitrani
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011379:Prognosis; D016016:Proportional Hazards Models; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants