Clinical Resources

Authored and endorsed clinical documents provide three main components vital to advancements in the heart rhythm field: analysis, discussion of current issues, and suggestions for clinical application.

HRS Clinical Document Methodology

The HRS Clinical Document Development Methodology Manual and Policies transparently declares the standards by which the HRS develops clinical practice documents, which include clinical practice guidelines, expert consensus statements, scientific statements, clinical competency statements, task force policy statements, and proceedings statements.

2021 ISHNE/HRS/EHRA/APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

Atrial Fibrillation
Clinical EP

January 29, 2021This ISHNE/HRS/EHRA/APHRS collaborative statement describes the current status of mobile health (mHealth) technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.


  The Spanish translation (Executive Summary) is available. 

2020 Update to the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults with Atrial Fibrillation or Atrial Flutter

HRS Endorsed / Affirmed
Atrial Fibrillation

The Heart Rhythm Society endorsed the document on August 6, 2020.

December 7, 2020—There were two changes to the performance measures, both prompted by recent changes to the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. The first, which impacts all the performance measures (see Appendix A, for the changes and measure specifications), is the clarification that valvular atrial fibrillation is atrial fibrillation with either moderate or severe mitral stenosis or a mechanical heart valve. The second change is the separation of a male and female threshold for the CHA2DS2-VASc score. This only applies to PM-5: Atrial Fibrillation/Atrial Flutter: Anticoagulation Prescribed.

2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy

HRS Endorsed / Affirmed

The Heart Rhythm Society endorsed the document on August 19, 2020.

November 20, 2020—The purpose of this guideline is to commission a full guideline revision of the 2011 ACCF/ AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy. This version replaces the 2011 guideline and addresses comprehensive evaluation and management of adults and children with hypertrophic cardiomyopathy. Diagnostic modalities such as electrocardiography, imaging and genetic testing, and management of patients include medical therapies, septal reduction therapies, sudden cardiac death risk assessment/prevention, and lifestyle considerations such as participation in activities/sports, occupation, and pregnancy.

2020 APHRS/HRS Expert Consensus Statement on the Investigation of Decedents with Sudden Unexplained Death and Patients with Sudden Cardiac Arrest, and of Their Families

Sudden Cardiac Arrest

October 19, 2020This expert consensus statement, developed in partnership between the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS) and in collaboration with the Association for European Cardiovascular Pathology (AECVP), the European Heart Rhythm Association (EHRA), the European Society of Human Genetics (ESHG), the Latin American Heart Rhythm Society (LAHRS), the National Society of Genetic Counselors (NSGC), the Pediatric and Congenital Electrophysiology Society (PACES), and the European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart), provides a framework for the investigation of patients with sudden cardiac arrest (SCA), decedents with sudden unexplained death (SUD), and families of both SCA survivors and SUD victims. 


 The document features a slide set and a video interview on Heart Rhythm TV.

Quality Indicators for the Care and Outcomes of Adults with Atrial Fibrillation: Task Force for the Development of Quality Indicators in Atrial Fibrillation of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC)

HRS Endorsed / Affirmed
Atrial Fibrillation

August 29, 2020—Developed in collaboration with the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS), this document presents quality indicator (QIs) for the diagnosis and management of adults with atrial fibrillation (AF). The document defines six domains of AF care (patient assessment, anticoagulation, rate control, rhythm control, risk factor management, and outcomes) and provides 17 main and 17 secondary QIs for the diagnosis and management of AF. It is anticipated that implementation of these QIs will improve the quality of AF care.

EHRA/HRS/APHRS/LAHRS Expert Consensus on Risk Assessment in Cardiac Arrhythmias: Use the Right Tool for the Right Outcome

Clinical EP
Atrial Fibrillation
Ablation
Sudden Cardiac Arrest

June 15, 2020—The expert consensus statement recommends how best to determine the likelihood of developing a heart rhythm disorder and how to assess the risk for poor outcome in patients with that condition. The document focuses on atrial fibrillation, the most common heart rhythm disorder and a major cause of disabling stroke, and ventricular tachyarrhythmia (fast heart rate), a leading cause of sudden cardiac death.

Guidance for Rebooting Electrophysiology Through the COVID-19 Pandemic from the Heart Rhythm Society and the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology

Clinical EP

June 12, 2020—In response to the challenges that the COVID-19 pandemic has created for electrophysiology (EP) practice, this document provides guidance for clinicians and institutions to reestablish safe EP care during the COVID-19 pandemic and addresses regional and local COVID-19 disease status, the role of viral screening and serologic testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.


 Recommended Resources: HRS COVID-19 Challenges & Solutions

HRS/EHRA/APHRS/LAHRS/ACC/AHA Worldwide Practice Update for Telehealth and Arrhythmia Monitoring During and After a Pandemic

Electrophysiology

June 11, 2020—The Heart Rhythm Society (HRS), the European Heart Rhythm Association (EHRA), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), the American College of Cardiology (ACC), and the American Heart Association (AHA) have partnered to address the strategies for telehealth and arrhythmia monitoring during and after the COVID-19 pandemic.

Rationale, Considerations, and Goals for Atrial Fibrillation Centers of Excellence: A Heart Rhythm Society Perspective

Atrial Fibrillation
Clinical EP

May 5, 2020—This document reviews the rationale for atrial fibrillation (AF) “centers of excellence” (CoE), the available evidence for integrated and multidisciplinary care, and future challenges and opportunities. It also defines the key priorities to be used as a guide for the Heart Rhythm Society (HRS) and its diverse stakeholders to build consensus on defining the core components of an AF CoE.

Considerations for Drug Interactions on QTc Interval in Exploratory COVID-19 Treatment

Clinical EP

April 14, 2020—The American Heart Association (AHA), the American College of Cardiology (ACC), and the Heart Rhythm Society (HRS) jointly developed this new guidance to detail critical cardiovascular considerations in the use of hydroxychloroquine and azithromycin for the treatment of COVID-19. The statement also includes a table rating potential adverse cardiac events of medications repurposed for COVID-19 treatment, such as chloroquine and lopinavir/ritonavir (antimalarial and antiviral agents, respectively).


 Recommended Resources: HRS COVID-19 Challenges & Solutions