• Alberto Conti, Andrea Alesi, Federica Trausi, Margherita Scorpiniti, Elena Angeli, Sofia Bigiarini, Simone Bianchi, Chiara Donnini, Delia Lazzeretti, and Luigi Padeletti.
• From the *Atrial Fibrillation Outpatient Clinic and Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy; and †Dysrhytmias Unit, Department of Cardiology; Careggi University Hospital, Florence, Italy.
• Crit Pathw Cardiol. 2014 Dec 1; 13 (4): 141-6.

BackgroundHypertension and atrial fibrillation (AFib) frequently coexist in clinical practice. However, it is unclear whether this association per se or in combination with coronary artery disease (CAD) is a predictor of adverse outcomes.AimThe aim of this study is to recognize and treat CAD in patients with hypertension and AFib.MethodsPatients with long-standing hypertension and recent-onset AFib (lasting ≤48 hours) were enrolled and managed with standard care regardless of the presence of troponin elevations (e-TnI) (group 1, n=636, 2010-2011 years) or managed with tailored-care including echocardiography and stress testing when presenting with e-TnI (group 2, n=663, 2012-2013 years).EndpointThe composite of ischemic vascular events including stroke, acute coronary syndrome, revascularization, and death at the 6-month follow-up.ResultsOut of 1299 patients enrolled, those with e-TnI (56 and 57 in groups 2 and 1, respectively, P=0.768) were more likely to admit in group 2 vs. group 1 (21 vs. 32, respectively, P=0.060), and less likely to undergo stress testing in group 2 vs. group 1 (15 vs. 1, respectively, P<0.001). Twenty-one patients in group 2 were admitted with positive stress testing (n=9) or high e-TnI (n=12; 1.04±1.98 ng/mL); conversely 35 were discharged with negative stress testing (n=6) or very-low e-TnI (n=29; 0.27±0.22 ng/mL). Finally, 7 patients vs. 1, in groups 2 and 1, respectively, underwent revascularization (P=0.032), and 3 vs. 12 reached the endpoint (P=0.024). On multivariate analysis, e-TnI, known CAD and age were predictors of the endpoint.ConclusionsIn patients with hypertension, AFib, and e-TnI, tailored-care inclusive of echocardiography and stress testing succeeded in recognizing and treating CAD avoiding adverse events without increase in admissions.

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