Atrial Fibrillation Centers of Excellence: The best path forward for high-quality care and better outcomes
The world is in the throes of an atrial fibrillation (AFib) pandemic, one that could potentially get worse in the years ahead due to population growth, economic hardships and rigid resource limitations.
The most effective way to combat this pandemic is to develop more AFib Centers of Excellence, according to the Heart Rhythm Society. However, the group warns, these centers must represent true collaborations from a wide variety of healthcare specialties to really make a difference. It is not just cardiology and electrophysiology (EP) that need to work together, it is also the fields of cardiovascular surgery, vascular medicine, neurology, primary care, emergency medicine, hematology, gastroenterology, and many more.
HRS has published a new framework detailing what it takes to develop and maintain an AFib Center of Excellence. The document, available in full in Heart Rhythm, represents an update of guidelines originally published back in 2020.[1] Representative of 19 different healthcare groups from all over the world provided assistance.
“Optimal, coordinated care for AFib is best delivered at Centers of Excellence, where comprehensive education, resources and data-driven approaches ensure the highest standard of treatment,” T. Jared Bunch, MD, chair of the AFib Centers of Excellence Task Force, said in a prepared statement. “HRS believes that all healthcare facilities, whether academic or non-academic, urban or rural, can achieve excellence in AFib care by following fundamental principles and collaborating across health systems when needed.”
The importance of continuous quality improvement
One of the biggest takeaways from this updated framework is its focus on continuous quality improvement (CQI). AFib Centers of Excellence should always push forward and try to provide the very best care possible. To do so requires acquiring accurate data, evaluating clinician performance, tracking patient outcomes and successfully identifying new ways to get better.
“Whether an AFib Center of Excellence uses internal or external databases to generate outcome data, the most important factor is that the center has a standardized review process,” the authors wrote. “It should identify a team of champions who meet regularly to not only review the data but also implement strategies that can provide for CQI and reduce unfavorable outcomes, such as morbidity and mortality meetings.”
The writing group added that care teams must meet regularly to review these topics. One example included in the document is a “monthly morbidity and mortality meeting” that allows participating specialists to review individual cases, learn from past mistakes and implement changes going forward.
Atrial Fibrillation Centers of Excellence goals for all practice settings. Image courtesy of the Heart Rhythm Society.
Optimal care requires many moving parts
Another key takeaway from the new HRS framework is how crucial it is to optimize EP procedures. A dedicated EP lab is necessary, for example, and leaders must ensure that there is a plan in place to handle unexpected emergencies when they occur. When pericardial effusions, cardiac tamponade or vascular complications happen, the authors wrote, procedural or surgical interventions may be necessary at a moment’s notice.
“Rigorous peer review” is also required to “ascertain the root cause(s) of complications and to develop strategies to reduce them in the future.”
Education efforts are essential
Education among both heart patients and healthcare providers will play a significant role in any AFib Center of Excellence. Educational efforts will need to be updated as technologies and techniques evolve over time, of course, and the HRS document noted that it is vital to avoid biased resources that may not be accurate or honest.
“Educational programs focused on the pillars of AFib management (stroke risk reduction, optimization of modifiable risk factor management approaches, reduction of symptoms by focusing on rhythm and rate control as warranted) are important,” the authors wrote. “Engaging patients and their caregivers in discussions regarding topics that they feel are most important to them might improve adherence and hopefully clinical outcomes. Similarly, educational efforts that indicate the variation in clinical presentation, and therefore the possible need to prioritize diagnostic and therapeutic options based on the approaches, may be warranted.”
Click here to read the full HRS framework in Heart Rhythm.
HRS released this new framework right before Heart Rhythm 2025, the organization’s annual meeting. Additional details are available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.