Centers of Excellence Optimal Management Pathways for Atrial Fibrillation Specialty Services (COMPASS) early rhythm control treatment care pathway: A quality improvement initiative

Background: Early rhythm control improves cardiovascular outcomes in recently diagnosed atrial fibrillation (AF) patients. Whether care pathways are a tool to improve translation into clinical practice needs evaluation. Objective: The Centers of Excellence Optimal Management Pathways for Atrial Fibrillation Specialty Services (COMPASS) Early Rhythm Control Treatment Care Pathway program aims to assess the utility of care pathways to increase initiation of early rhythm control, establish specialty care (cardiology/electrophysiology), and improve stroke prevention. Methods: This multicenter, pre-post study of recently diagnosed patients with AF (within 12 months) was conducted at 3 different health systems (Duke University Medical Center, Cedars-Sinai Medical Center, and Texas Cardiac Arrhythmia Institute). Each center, using a set of common core elements, tailored an intervention for an Early Rhythm Control Treatment Care Pathway. Patients with AF were identified using electronic health records (EHRs) and historical control groups were defined in the year before the COMPASS program interventions. The interventions were care pathways and EHR-based protocols for AF management to coincide with a rapid access AF clinic/patient education/provider education (Duke University Medical Center), EHR-based passive best practice alert/patient education/provider education (Cedars-Sinai Medical Center), and patient/provider education (Texas Cardiac Arrhythmia Institute). Each patient had 6 months of follow-up. The primary outcome was the change in the rate of early rhythm control (antiarrhythmic drugs or catheter ablation). Secondary outcomes were changes in specialty care access (cardiology or electrophysiology visits) and guideline-concordant oral anticoagulation use. Conclusion: This study will provide information on the effectiveness of care pathways to improve the quality of care for patients recently diagnosed with AF.