April 23, 2025 – The Heart Rhythm Society (HRS) has released a framework outlining criteria for establishing an Atrial Fibrillation (AF) Center of Excellence (CoE) and key operational standards to provide multidisciplinary care for AF patients.
AF, the most common arrhythmia disorder, is becoming more prevalent across the United States, affecting an estimated 10.5 million adults.1 As the prevalence of AF continues to grow, so does the complexity of managing this disease. Providing high-quality care for AF demands a specialized center for early diagnosis and prompt multidisciplinary treatment to reduce the risks of stroke, heart failure, and mortality, ensuring patients receive appropriate interventions to restore normal heart rhythm while addressing underlying risk factors.
Previously, HRS released a position paper announcing the rationale for creating integrated, highly functioning AF CoEs. This new framework, developed in collaboration with experts from 19 international institutions, outlines the requirements for becoming an AF CoE and describes the expectations for maintaining this status to ensure exceptional patient care. These centers will serve as specialized hubs to improve patient outcomes, streamline care coordination, and enhance the quality of life for those affected by AF.
“Optimal, coordinated care for atrial fibrillation is best delivered at Centers of Excellence, where comprehensive education, resources, and data-driven approaches ensure the highest standard of treatment,” said T. Jared Bunch, MD, FACC, FHRS, Chair of the AF Centers of Excellence Task Force. “HRS believes that all healthcare facilities, whether academic or non-academic, urban or rural, can achieve excellence in atrial fibrillation care by following fundamental principles and collaborating across health systems when needed.”
The framework offers a blueprint and checklist for establishing an AF CoE, outlining five key pillars:
- Early patient identification and access
- Evidence-based care pathways
- Optimization of electrophysiology (EP) procedures
- Outcomes reporting
- Comprehensive education
To facilitate adoption and scalability, the AF CoE concept incorporates a Tiers for Accountability model, allowing centers to assess their progress from foundational to comprehensive levels of performance.
Recognizing that not all institutions have facilities that can provide the full spectrum of services required to care for AF patients, this framework also introduces the concept of AF Cooperatives—formalized partnerships between institutions designed to ensure access to specialized care.
The full document was published in the online edition of Heart Rhythm, the official journal of the Heart Rhythm Society.
For more information, visit www.HRSonline.org.
1. Noubiap JJ, Tang JJ, Teraoka JT, Dewland TA, Marcus GM. Minimum national prevalence of diagnosed atrial fibrillation inferred from California acute care facilities. Journal of the American College of Cardiology. 2024; 84(16): 1501-8.
June 16, 2025 
