The primary endpoint occurred most frequently in the highest tertile of the AFSS [ 16 ( 9 % ) , 19 ( 10 % ) , 36 ( 19 % ) , respectively , P = 0.01 ] , being mainly driven by heart failure hospitalizations [ 4 ( 2 % ) , 1 ( 1 % ) , 16 ( 8 % ) , respectively , P < 0.001 ] .