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

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.

HRS Endorsed / Affirmed
Atrial Fibrillation


  1. This document describes updates to the atrial fibrillation performance measures that are appropriate for public reporting or pay-for-performance programs.
  2. The performance measures are taken from the 2019 American College of Cardiology/American Heart Association/Heart Rhythm Society atrial fibrillation guideline update and are selected from the strongest recommendations (Class 1 or 3).
  3. Quality measures are provided that are not yet ready for public reporting or pay-for-performance programs but might be useful for clinicians and healthcare organizations for quality improvement.
  4. The recent guideline change regarding the definition of valvular atrial fibrillation is now incorporated into the performance measures. This includes patients with moderate or severe mitral stenosis and those with a mechanical prosthetic heart valve.
  5. The recent guideline changes regarding different CHA2DS2-VASc risk score treatment thresholds for men (>1) and women (>2) are now incorporated into the performance measures.