{"doi":"10.1016/j.jchf.2022.01.018","title":"Atrial Fibrillation in Heart Failure With Preserved Ejection Fraction","abstract":"OBJECTIVES: In this study, the authors sought to assess the relationship between AFF and outcomes, the treatment response to sacubitril/valsartan and first-detected AFF in patients with HFpEF enrolled in the PARAGON-HF trial. BACKGROUND: Atrial fibrillation and flutter (AFF) are common in heart failure with preserved ejection fraction (HFpEF) and increase the risk of adverse outcomes. METHODS: A total of 4,776 patients formed 3 groups: those with AFF according to electrocardiography (ECG) at enrollment (n = 1,552; 33%), those with history of AFF but without AFF on ECG at enrollment (n = 1,005; 21%), and those without history of AFF or AFF on ECG at enrollment (n = 2,219, 46%). We assessed outcomes, treatment response to sacubitril/valsartan in each group, and the risk associated with first-detected AFF in patients without any known AFF. The primary outcome was a composite of total heart failure hospitalizations and cardiovascular death. RESULTS: History of AFF and AFF at enrollment were associated with higher risk of the primary outcome (risk ratio [RR]: 1.36 [95% CI: 1.12-1.65] and RR: 1.31 [1.11-1.54], respectively), than no AFF. Neither history of AFF nor AFF at enrollment modified the treatment effect of sacubitril/valsartan. Post randomization AFF occurred in 12% of patients without previous AFF and was associated with 2.8-fold higher risk of the primary outcome, but it was not influenced by sacubitril/valsartan. CONCLUSIONS: History of AFF and AFF on ECG at enrollment were associated with a higher risk of the primary outcome. First-detected AFF was not influenced by sacubitril/valsartan, yet it was associated with increased risk of all subsequent outcomes and may represent a potential target for future HFpEF trials. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).","journal":"JACC Heart Failure","year":2022,"id":240446,"datarank":1.3345128427788757,"base_score":3.828641396489095,"endowment":3.828641396489095,"self_citation_contribution":0.5742962094733643,"citation_network_contribution":0.7602166333055114,"self_endowment_contribution":0.5742962094733643,"citer_contribution":0.7602166333055114,"corpus_percentile":null,"corpus_rank":null,"citation_count":45,"citer_count":35,"citers_with_citation_signal":29,"citers_with_endowment":29,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8322,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT01920711"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":867814,"name":"Ivo Planinc","orcid":"0000-0003-0561-6704","position":1,"is_corresponding":false},{"id":28286,"name":"Brian Claggett","orcid":"0000-0002-4215-9218","position":2,"is_corresponding":false},{"id":899,"name":"Jonathan W. Cunningham","orcid":"0000-0003-4481-7867","position":3,"is_corresponding":false},{"id":424406,"name":"Davor Miličić","orcid":"0000-0001-9101-1570","position":4,"is_corresponding":false},{"id":260611,"name":"Nancy K. Sweitzer","orcid":"0000-0002-8117-6678","position":5,"is_corresponding":false},{"id":280684,"name":"Michele Senni","orcid":"0000-0001-5502-7882","position":6,"is_corresponding":false},{"id":867815,"name":"Mauro Gori","orcid":"0000-0001-5509-8867","position":7,"is_corresponding":false},{"id":627845,"name":"Gerard C.M. Linssen","orcid":"0000-0002-3339-1955","position":8,"is_corresponding":false},{"id":235994,"name":"Sanjiv J. Shah","orcid":"0000-0002-5655-8201","position":9,"is_corresponding":false},{"id":92418,"name":"Milton Packer","orcid":"0000-0003-1828-2387","position":10,"is_corresponding":false},{"id":39751,"name":"Marc A. Pfeffer","orcid":"0000-0003-3876-7568","position":11,"is_corresponding":false},{"id":92424,"name":"Michael R. Zile","orcid":"0000-0001-7076-221X","position":12,"is_corresponding":false},{"id":57257,"name":"Inder S. Anand","orcid":"0000-0003-1308-4963","position":13,"is_corresponding":false},{"id":868378,"name":"Lu‐May Chiang","orcid":null,"position":14,"is_corresponding":false},{"id":49640,"name":"Carolyn S.P. Lam","orcid":"0000-0003-1903-0018","position":15,"is_corresponding":false},{"id":288521,"name":"Margaret M. Redfield","orcid":"0000-0002-0946-7518","position":16,"is_corresponding":false},{"id":57261,"name":"Akshay S. Desai","orcid":"0000-0002-1443-0701","position":17,"is_corresponding":false},{"id":2612,"name":"John J.V. McMurray","orcid":"0000-0002-6317-3975","position":18,"is_corresponding":false},{"id":27970,"name":"Scott D. Solomon","orcid":"0000-0003-3698-9597","position":19,"is_corresponding":false},{"id":424397,"name":"Maja Čikeš","orcid":"0000-0002-4772-5549","position":0,"is_corresponding":true}],"reference_count":16,"raw_metadata":null,"created_at":"2026-07-19T00:22:46.554789Z","pmid":"35483796","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}