Troponin assessment in patients admitted to the emergency department with atrial fibrillation: which role in daily clinical practice?

Excerpt

Atrial fibrillation (AF) is the most common dysrhythmia observed and managed by emergency physicians in daily clinical practice. According to the latest epidemiological studies, the prevalence of AF rises with the aging of the general population [1], with clear implications in resource utilization and health costs. Moreover, it has been estimated that the number of patients with AF will rise to about 5.6 million in 2050 from its current number of 2.3 million cases [2]. Frequently, AF patients are admitted to the emergency department (ED) after the dysrhythmia onset, and, more in general, about 80% of the AF subjects will be admitted into a cardiological or internal medicine unit during the course of their illness [3]. Previous investigations and trials involving AF subjects have mainly investigated and elucidated clinical and therapeutical aspects of the disease, as the link between AF and the risk or the prevention of ischemic stroke. Conversely, data regarding the prognostic role of elevated cardiac troponin (cTn) values in AF patients, during both the short- and long-term period, are scarce. Nowadays, there are few recommendations about the use of cTn levels in the management of AF patients. Indeed, the latest European guidelines on the management of AF have considered this clinical issue only marginally [5]. Specifically, the aforementioned consensus document suggests the evaluation of cardiac biomarkers (both cTn and/or brain natriuretic peptide—BNP) to improve the estimation of stroke and bleeding events (level of evidence IIb-B) without giving any suggestions about the possible prognostic role, even in the short- and long-term period, after the dysrhythmia onset. …