Endomyocardial biopsy as the cornerstone of diagnostics has been re-evaluated throughout the years, leaving unanswered questions on the precedence of it. The reported incidence of myocarditis has increased during the pandemic of coronavirus disease 2019 (COVID-19), reinforcing discussions on appropriate diagnostics of myocarditis. By analysis of evidence-based literature published within the last demi-decade, we aimed to summarize the most recent information in order to evaluate the current role of endomyocardial biopsy in diagnostics and management of myocarditis. For the most part, research published over the last five years showed ongoing uncertainty regarding the use, informativeness, safety and necessity of performing a biopsy. Special circumstances, such as fulminant clinical course or failure to respond to empirical treatment, were reconfirmed as justified indications, with a growing applicability of non-invasive diagnostic approaches for most other cases. We concluded that endomyocardial biopsy, if performed properly and with adjunct diagnostic methods, holds a critical role for treatment correction in specific histological subtypes of myocarditis and for differential diagnosis between immune-mediated myocarditis and secondary infections due to immunosuppressive treatment. A high level of possible misdiagnosing was detected, indicating the need to review terminology used to describe findings of myocardial inflammation that did not meet Dallas criteria.

Background: Atrial fibrillation (AF) significantly impacts the clinical and financial burden of healthcare systems worldwide. Patient-reported outcomes (PROMs) are considered a core element of patient-centered care. However, the integration of PROMs into AF clinical pathways remains limited. Objectives: In this study, we aimed to develop a policy-oriented framework for integrating PROMs into AF management, building on QoL assessment and the AF-CARE pathway. Methods: We compared the selected instruments (AFEQT, SF-36, EQ-5D, and AFSS) to examine how different QoL domains are represented. We then considered how the missing domains relate to routine care and healthcare delivery. On this basis, we constructed a conceptual framework linking PROM domains with clinical and policy decisions, as well as with diagnostic and follow-up strategies in AF. Results: Existing PROMs capture symptom burden reasonably well, but they do not fully reflect several domains that shape the daily experience of patients with AF, including cognition, sleep quality, sexual health, and economic burden. The proposed framework places PROMs within the AF-CARE components and illustrates how they can be used in routine practice—not only for long-term monitoring, but also to improve clinical decision-making, and better align with value-based healthcare strategies at both the clinical and system levels. It also outlines a practical approach to incorporating PROMs into everyday care and into broader health-system decision-making. Conclusions: Integrating PROMs into AF-CARE requires a system-level redesign rather than isolated tool implementation. Within the proposed framework, the question is no longer whether PROMs should be used in AF care, but how to integrate them in a way that meaningfully influences clinical decisions and patient outcomes.