Heart Rhythm 2026: COMPASS Initiative Benefits Early Rhythm Control Treatment

The Heart Rhythm Society shared the first analysis of its Centers of Excellence Optimal Management Pathways for Atrial Fibrillation Specialty Services Early Rhythm Control Treatment Care Pathway (COMPASS) initiative, which evaluated the impact of structured care pathways for patients with newly-diagnosed atrial fibrillation (AF).

The study found that hospitals implementing the COMPASS program significantly increased the use of early rhythm control (ERC) therapies compared with centers without a standardized care pathway. Researchers presented these findings today as a late-breaking clinical trial at Heart Rhythm 2026 in Chicago.

An irregular or rapid heartbeat, AF is the most common heart rhythm disorder, and its prevalence continues to rise, with an estimated 12.2 million people in the United States expected to be diagnosed with AF by 2050.ⁱ AF is a major risk factor for stroke, heart failure, and mortality, making early diagnosis and appropriate treatment critical. ERC, which targets timely restoration and maintenance of normal heart rhythm through medications, cardioversion, or catheter ablation, has been shown to reduce the risk of adverse cardiovascular outcomes compared with strategies that focus first on rate control.ⁱⁱ Despite this, many patients newly diagnosed with AF do not receive ERC.

The COMPASS program is a strategic initiative to design and implement care pathways that enhance patient care quality within health systems. This comprehensive approach leverages electronic medical record (EMR) integration, along with data-driven measurement and feedback, to inform and deliver targeted education initiatives within those systems. The first COMPASS program focuses on ERC, aiming to address treatment gaps that can arise early in managing AF.

This initial analysis included a multicenter cohort of more than 14,000 patients with an AF diagnosis within 12 months, across three major health systems: Duke University Medical Center, Cedars-Sinai Medical Center, and Texas Cardiac Arrhythmia Institute. Using a set of common core elements, each center tailored an implementation program with the goal of increasing the use of ERC treatments. These programs included care pathways—standardized clinical plans for diagnosing and managing specific conditions—patient and provider education, and electronic health record (EHR) tools that use patient data to guide protocol-based recommendations and clinical alerts.

The analysis showed meaningful improvements in care following COMPASS implementation. Rhythm control treatment increased from 28.8% of patients in the pre-intervention period to 32.8% in the post-intervention period. Additionally, access to specialty care improved, increasing from 22.6% pre-intervention to 25% post-intervention, and AF ablation procedures increased significantly, increasing from 7.1% before implementation to 12.5% following implementation.

“Early rhythm control can change the trajectory of care for patients with atrial fibrillation, yet consistent implementation in everyday practice remains challenging,” said Sean Pokorney, M.D., cardiologist and electrophysiologist at Duke University Medical Center. “The first analysis of the COMPASS initiative shows how structured care pathways can turn evidence into action, improving access to early rhythm control and helping reduce the growing burden of AF-related hospitalizations and deaths.”

Because ERC strategies are associated with lower risks of cardiovascular events compared with usual care, and AF accounts for approximately 450,000 hospitalizations annually in the U.S.,ⁱⁱⁱ broader implementation of COMPASS could help reduce AF-related complications and hospitalizations, improving outcomes for patients while reducing the workload and challenges faced by clinicians managing AF.

Further studies and broader adoption of care pathways are planned to better understand which components of the intervention had the greatest impact and to determine whether COMPASS ultimately improves long-term patient outcomes.

The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients and is the primary information resource on heart rhythm disorders. Its mission is to improve patient care by promoting research, education, and optimal healthcare policies and standards. Incorporated in 1979 and based in Washington, D.C., its membership consists of more than 9,000 heart rhythm professionals from 94 countries.

The Heart Rhythm Society’s annual Heart Rhythm meeting convenes 10,000 of the world’s clinicians, scientists, researchers, and innovators in cardiac pacing and electrophysiology. More than 2,000 international experts in the field serve as faculty for the 200-plus educational sessions, forums, symposia, and ceremonies, while over 110 exhibitors showcase their products and services.

References
ⁱ U.S. Centers for Disease Control and Prevention. (2024, May 14). About Atrial Fibrillation. https://www.cdc.gov/heart-disease/about/atrial-fibrillation.html
ⁱⁱ Kirchhof P, Camm AJ, Goette A, Brandes A, Eckardt L, Elvan A, Fetsch T, van Gelder IC, Haase D, Haegeli LM, et al; EAST-AFNET 4 Trial Investigators. Early rhythm-control therapy in patients with atrial fibrillation. N Engl J Med. 2020;383:1305–1316. doi: 10.1056/NEJMoa2019422
ⁱⁱⁱ January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American heart association task force on practice guidelines and the heart rhythm society. J Am Coll Cardiol. 2014;64(21):e1–e76. doi: 10.1016/j.jacc.2014.03.022.