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Global experts define how to assess quality of care for patients with atrial fibrillation

Atrial Fibrillation
Clinical Skills

Sophia Antipolis – 24 April 2021:  The first internationally agreed quality indicators for the management and outcomes of adults with atrial fibrillation are presented today at EHRA 2021, an online scientific congress of the European Society of Cardiology (ESC).1 The document is published in EP Europace,2 a journal of the ESC.

Atrial fibrillation is the most common heart rhythm disorder, affecting more than 40 million people globally.3 Those with the disorder have increased risks of complications including stroke, heart failure and dementia, and are twice as likely to be admitted to hospital as their peers without the condition. The economic burden of atrial fibrillation is rising, mainly due to complications and hospitalisations.4 Effective therapies exist (e.g. to prevent stroke) but are not consistently used.5

Lead author Dr. Elena Arbelo of the University of Barcelona, Spain said: “We hope the quality indicators will help institutions to assess and monitor adherence to clinical practice guidelines. Ultimately this should lead to improved quality of care for patients with atrial fibrillation.”

The expert group, which included patients with atrial fibrillation, used the ESC methodology for developing quality indicators.6 Briefly, this involved: 1) identifying domains of care for the diagnosis and management of atrial fibrillation; 2) reviewing the literature and constructing candidate quality indicators for each domain; 3) selecting the final set of quality indicators through a series of votes.

Six domains of care were identified: patient assessment at baseline and follow-up, anticoagulation therapy, rate control strategy, rhythm control strategy, risk factor management, and outcomes.

Quality indicators were chosen for each domain. For example, a quality indicator in the patient assessment domain was the proportion of patients assessed for stroke risk. In the anticoagulation domain, one quality indicator was the proportion of patients appropriately prescribed this stroke prevention therapy. For risk factor management, the indicator was the proportion of patients with these factors identified (e.g. obesity, smoking, high blood pressure, obstructive sleep apnoea, alcohol excess, lack of exercise, and poor glycaemic control).

The outcomes domain describes quality indicators for the consequences of the disease (e.g. stroke, hospitalisation), complications of treatment (e.g. bleeding), and patient-reported outcomes (e.g. assessment of quality of life, symptoms, emotional well-being, and cognitive function).

A summary of the quality indicators is incorporated into ESC guidelines for the diagnosis and management of atrial fibrillation.3 “This should enhance their dissemination and uptake into clinical practice,” said Dr. Arbelo. “Modern healthcare demands that we evaluate the standard of care patients receive and their outcomes. It is essential that the patient’s perspective is taken into account, particularly since most atrial fibrillation therapies aim to improve symptoms, well-being, and quality of life.”

The statement was developed by the European Heart Rhythm Association (EHRA) of the ESC in collaboration with the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS).



Notes to editor

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Funding: N/A


Disclosures: Please visit the supplementary material online.


References and notes

1Session: “Scientific reports” on 24 April at 10:05 to 11:00 CEST.

2Arbelo E, Aktaa S, Bollmann A, et al. Quality indicators for the care and outcomes of adults with atrial fibrillation. Europace. 2020. doi:10.1093/europace/euaa253.

3Hindricks G, Potpara T, Nikolaos Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373–498.

4Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893–2962.

5Boriani G, Proietti M, Laroche C, et al. Contemporary stroke prevention strategies in 11 096 European patients with atrial fibrillation: a report from the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) long-term general registry. Europace. 2018;20:747–757.

6Aktaa S, Batra G, Wallentin L, et al. European Society of Cardiology methodology for the development of quality indicators for the quantification of cardiovascular care and outcomes. Eur Heart J Qual Care Clin Outcomes. 2020. doi:10.1093/ehjqcco/qcaa069.


About the European Heart Rhythm Association

The European Heart Rhythm Association (EHRA) is a branch of the European Society of Cardiology (ESC). Its aim is to improve patients’ quality of life and reduce sudden cardiac death by limiting the impact of heart rhythm disturbances. 


About the EHRA Congress  #EHRA2021

EHRA 2021 is the online annual congress of the European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC).


About the European Society of Cardiology

The ESC brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people to live longer, healthier lives.


About the Heart Rhythm Society

The Heart Rhythm Society (HRS) is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards. Incorporated in 1979 and based in Washington, DC, it has a membership of more than 7,000 heart rhythm professionals in more than 72 countries around the world. For more information, visit


About the Asia Pacific Heart Rhythm Society

The Asia Pacific Heart Rhythm Society (APHRS) is the international organisation specialising in science and education for cardiac arrhythmia professionals. For members, the society regularly offers various educational programmes at the state-of-the-art laboratories with excellent lectures. For more information, visit


About the Latin American Heart Rhythm Society

The Latin American Heart Rhythm Society (LAHRS) was founded in 2017 with the aim of continuing the mission started by Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE) more than twenty years ago, promoting the improvement of the quality of life and reducing mortality related to cardiac arrhythmias in the Latin American population. For more information, visit


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