Establishing Atrial Fibrillation Centers of Excellence (=AF CoEs)
Establishing Atrial Fibrillation Centers of Excellence (=AF CoEs)
Source: Heart Rhythm Journal (Heart Rhythm Society)
Publication Date: April 2024
Authors: HRS Task Force
(Multispecialty)
Key Points:
1. Rationale for AF CoEs
• AF is a global epidemic with significant health and economic burdens.
• There is substantial variation in AF care quality across health systems.
• A structured, multidisciplinary AF CoE model is essential to standardize, optimize, and sustain high-quality AF care.
2. Core Pillars of AF Management (per 2023 ACC/AHA/HRS and ESC Guidelines)
• Stroke prevention
• Risk factor optimization
• Symptom and burden reduction (via rate/rhythm control)
• ESC’s AF-CARE model: Comorbidity control, Avoid stroke, Rate/rhythm control, Evaluation & reassessment
3. Integrated Multidisciplinary Team Approach
• Core team includes: EPs, cardiologists, primary care, neurology, sleep medicine, pharmacists, nurses, APPs, surgeons, behavioral health, etc.
• Strong emphasis on care coordination, communication, and continuity across inpatient and outpatient settings.
4. Risk Factor Management – “HEAD2TOES”
• Heart failure
• Exercise
• Arterial hypertension
• Diabetes type 2
• Tobacco use
• Obesity
• Ethanol
• Sleep quality
5. Care Pathways
• Early intervention is key—ideally at first AF encounter.
• Care pathways should address primary and secondary prevention.
• Must include stroke risk stratification and management, rhythm/rate control, and modifiable lifestyle interventions.
• Consumer and medical-grade devices must be integrated for early AF detection and ongoing monitoring.
6. EP Laboratory Optimization
• Requires high-end equipment, trained staff, anesthesia support, and emergency readiness.
• Comprehensive management before and after ablation procedures.
• Regular peer reviews, procedural audits, and adverse event tracking are mandatory.
7. Outcome Reporting and Continuous Quality Improvement (CQI)
• Mandatory performance measurement systems.
• Internal databases and/or national registries (e.g., AHA’s GWTG-AF, ACC NCDR, REAL-AF).
• Regular reviews of morbidity, mortality, recurrence, quality of life (QoL), and patient-reported outcomes.
8. Education
• Patient and caregiver education: Multimodal (apps, videos, in-person), adapted to literacy and language needs.
• Clinician and staff education: Standardized CME, credentialing, updates aligned with latest evidence.
9. Practice Models and Flexibility
• AF CoEs can be based in private, academic, or multispecialty settings.
• Must coordinate across employment models and offer the full spectrum of AF care.
• For missing services (e.g., ablation or cardiac surgery), AF Cooperatives can be formed to ensure access.
10. Credentialing and Accountability Tiers
• Core level: Foundational data tracking and case reviews.
• Intermediate: Database-driven QI and institutional education.
• Comprehensive: Registry participation, research, and inter-institutional collaboration.
11. Checklist for High-Functioning AF CoEs (Table 1 in article)
• Early AF detection pathways
• Integrated team-based care
• Multilevel stroke prevention (including non-pharmacologic)
• Routine monitoring infrastructure
• EP lab standards and safety protocols
• Emergency referral systems
• Institutional support for sustainable growth and CQI
12. Conclusion
• AF CoEs can deliver equitable, guideline-aligned, and scalable care.
• A true commitment to CQI, patient-centered care, and interdisciplinary coordination is essential.
• These centers represent the gold standard for future AF management.
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