{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T12:04:00Z","timestamp":1769256240677,"version":"3.49.0"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013642","name":"Japan Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013642","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We previously reported that the heart rate (HR) at the time closest to an event or at the last visit during the follow\u2010up period (HR\u2010end) was more closely associated with adverse events (AEs) than baseline HR in patients with non\u2010valvular atrial fibrillation (NVAF). However, it remains uncertain whether changes in HR during the follow\u2010up period or absolute HR values would be more closely associated with AEs. Thus, we performed post hoc analyses using data from the J\u2010RHYTHM Registry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Of 7406 outpatients with NVAF from 158 institutions, 6886 (age, 69.8\u2009\u00b1\u20099.9 years; men, 70.8%), who had both baseline HR and HR\u2010end data, were included. Patients were divided into five groups based on the changing patterns of HR quartiles from baseline (&lt;\u200963, 63\u201370, 71\u201379, and \u2265\u200980 beats per minute) to the end of follow\u2010up (no\u2010change, down\u2010to\u2010the\u2010lowest\u2010quartile, down\u2010to\u2010the\u20102nd or \u20103rd\u2010quartile, up\u2010to\u2010the\u20102nd or \u20103rd\u2010quartile, and up\u2010to\u2010the\u2010highest\u2010quartile).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Hazard ratios for AEs were significantly higher only in the up\u2010to\u2010highest\u2010quartile group (2.89 [95% confidence interval, 1.71\u20134.90] for thromboembolism, 2.46 [1.53\u20133.95] for major hemorrhage, and 2.36 [1.51\u20133.70] for all\u2010cause death) compared with the no\u2010change group, after adjusting for confounding factors. Furthermore, in the no\u2010change group, hazard ratios for AEs were significantly higher in the highest\u2010to\u2010highest\u2010quartile subgroup (5.55 [1.49\u201320.77] for major hemorrhage and 3.60 [1.03\u201312.53] for all\u2010cause death) compared with the 2nd\u2010to\u20102nd\u2010quartile subgroup.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Both excessive increases in HR and consistently high HR were independently associated with AEs in patients with NVAF. By contrast, modest decrease in HR during follow\u2010up was associated with lower mortality. Accordingly, it is important to pay attention to changes in HR during follow\u2010up for the management of patients with AF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p>The J\u2010RHYTHM Registry is registered in the University Hospital Medicine Information Network (UMIN) Clinical Trials Registry (unique identifier: UMIN000001569) <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.umin.ac.jp\/ctr\/\">http:\/\/www.umin.ac.jp\/ctr\/<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.70122","type":"journal-article","created":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T01:52:11Z","timestamp":1743299531000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association Between Changes in Heart Rate and Adverse Events in Patients With Non\u2010Valvular Atrial Fibrillation: A Post Hoc Analysis of the J\u2010RHYTHM Registry"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4271-3186","authenticated-orcid":false,"given":"Eitaro","family":"Kodani","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Yamashita","sequence":"additional","affiliation":[{"name":"The Cardiovascular Institute Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Inoue","sequence":"additional","affiliation":[{"name":"Saiseikai Toyama Hospital Toyama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8181-9154","authenticated-orcid":false,"given":"Hirotsugu","family":"Atarashi","sequence":"additional","affiliation":[{"name":"Nippon Medical School Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3202-7203","authenticated-orcid":false,"given":"Ken","family":"Okumura","sequence":"additional","affiliation":[{"name":"Saiseikai Kumamoto Hospital Kumamoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9618-7361","authenticated-orcid":false,"given":"Hideki","family":"Origasa","sequence":"additional","affiliation":[{"name":"The Institute of Statistical Mathematics Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"J\u2010RHYTHM Registry 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