The Heart Rhythm Society (HRS) has announced the first analysis of its COMPASS initiative, which is evaluating the impact of structured care pathways for patients with newly diagnosed atrial fibrillation (AF). The study found that hospitals implementing the COMPASS programme significantly increased the use of early rhythm control (ERC) therapies compared to centres without a standardised care pathway.
Researchers presented these findings as a late-breaking clinical trial at the 2026 HRS annual meeting (23–26 April, Chicago, USA).
A press release from the HRS details that 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. Despite this, many patients newly diagnosed with AF do not receive ERC, the release adds.
The COMPASS programme 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 programme focuses on ERC, and is aiming to address treatment gaps that can arise early in the management of AF.
The initial analysis presented at HRS 2026 included a multicentre cohort of more than 14,000 patients with an AF diagnosis within 12 months across three major health systems: Duke University Medical Center (Durham, USA), Cedars-Sinai Medical Center (Los Angeles, USA), and Texas Cardiac Arrhythmia Institute (Austin, USA). Using a set of common core elements, each centre tailored an implementation programme with the goal of increasing the use of ERC treatments. These programmes included care pathways—standardised 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.
“ERC can change the trajectory of care for patients with AF, yet consistent implementation in everyday practice remains challenging,” said Sean Pokorney (Duke University Medical Center, Durham, USA). “The first analysis of the COMPASS initiative shows how structured care pathways can turn evidence into action, improving access to ERC, and helping reduce the growing burden of AF-related hospitalisations and deaths.”
According to the HRS, because ERC strategies are associated with lower risks of cardiovascular events compared with usual care—and AF accounts for approximately 450,000 hospitalisations annually in the USA—broader implementation of COMPASS could help reduce AF-related complications and hospitalisations, improving outcomes for patients while reducing the workload and challenges faced by clinicians managing the condition.
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.
