Heart Rhythm Society Reports First Success of COMPASS Initiative for Early Atrial Fibrillation Care

CHICAGO, IL, APRIL 24, 2026 – The Heart Rhythm Society announced 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.

AF, an irregular or rapid heartbeat, 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 have 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 the management of AF.

This initial analysis included a multicenter cohort of over 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.

“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, MD, MBA, 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.

Additional Session Details

“Late-Breaking Clinical Trials: Clinical Electrophysiology: Centers of Excellence Optimal Management Pathways for Atrial Fibrillation Specialty Services Early Rhythm Control Treatment Care Pathway: Primary Results of the COMPASS Heart Rhythm Society Quality Improvement Initiative” [Friday, April 24, 2026, at 10:00 am CT]

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.

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About the Heart Rhythm Society

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 the care of patients by promoting research, education, and optimal healthcare policies and standards. Incorporated in 1979 and based in Washington, D.C., it has a membership of more than 9,000 heart rhythm professionals from 94 countries. For more information, visit www.HRSonline.org.

About Heart Rhythm 2026

The Heart Rhythm Society’s annual Heart Rhythm meeting convenes 10,000 of the world’s finest clinicians, scientists, researchers, and innovators in cardiac pacing and electrophysiology. More than 2,000 international experts in the field will serve as faculty for the 200+ educational sessions, forums, symposia, and ceremonies, while 110+ exhibitors will showcase innovative products and services. For more information visit HeartRhythm.com.