What are some of the limitations associated with the use of biomarkers to manage atrial fibrillation?
Caveats with the use of these biomarkers include the inter- and intra-patient and assay variability; some have a diurnal variation and can be highly influenced by associated comorbidities and drug therapies. Many biomarkers are nonspecific for a particular end point and can be equally predictive not only of stroke but bleeding, death, hospitalization, HF, etc, as well as noncardiac conditions (eg, glaucoma). The importance of biomarkers probably lies in the very low risk strata of clinical scores (eg, CHA2DS2-VASc 0-1 group) where they may influence the decision to anticoagulate, yet there are limited data available in these patients. There are several other hurdles, including variations in availability in health-care systems, biomarker assays, access to laboratories, biomarkers diurnally, by comorbidities and by anticoagulation and other therapies. For these reasons, the clinical application of biomarkers in management of AF is unlikely to be significant.