The American College of Cardiology (ACC) and the American Heart Association (AHA) recently released guidance regarding performance and quality measures for patients with atrial fibrillation. This 2026 guidance updates the 2020 Update to the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter and the 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter guidance documents.

In total, three measures were retired, nine were revised, and seventeen are new. Today, we’re covering the new measures outlined in the 2026 ACC/AHA Clinical Performance and Quality Measures for Patients with Atrial Fibrillation. The following includes both performance measures and quality measures, organized by care setting. For the complete look at all the measures outlined, including their associated rationale, view the full-text version of the 2026 ACC/AHA guidance.

New Measures in the ACC/AHA 2026 Clinical Performance and Quality Measures for Patients with Atrial Fibrillation Guidance

Care Setting: Inpatient

  • LAA Exclusion During Cardiac Surgery in Patients with AF: Evidence-based practice to improve outcomes.
  • Acute Rate Control in Patients With Uncontrolled AF: Important for improved AF outcomes.
  • PVI as Primary Lesion Set for AF Ablation: Fundamental and most evidence-based procedural endpoint relevant to all AF ablations.
  • AF in Acute Medical Illness or Surgery: Important for patient-centered care and may be useful to improve local quality of care. Cumulative evidence supports high rates of AF recurrence in patients with AF detected during acute medical illness or surgery. Patient counseling to inform patients of the detection of AF during acute medical illness or surgery and the likely recurrence and need for further care.

Care Setting: Outpatient

  • SDM for Rhythm- Versus Rate-Control Strategies for AF: Important for the delivery of patient-centered care.

Care Setting: Inpatient/Outpatient

  • Basic Clinical Evaluation for Newly Diagnosed AF: Emphasizes the importance of verifying the diagnosis of AF and identifying clinical factors that will alter management, including stroke and bleeding risk factors.
  • Comprehensive Care and Secondary Prevention for AF: Comprehensive lifestyle and risk factor modification and comorbidity management are strongly guideline-recommended, evidence-based strategies that reduce AF burden and adverse outcomes, warranting a new measure to ensure systematic implementation.
  • DOACs and Dual Therapy for Patients with AF Who Undergo PCI: For patients with AF undergoing PCI, DOACs in combination with antiplatelet therapy is associated with a lower risk of bleeding compared with VKAs with antiplatelet therapies. Similarly, dual therapy with OAC and P2Y12 reduces the risk of bleeding compared with triple therapy with OAC, P2Y12, and aspirin after PCI.
  • Equitable AF Management: Central issue for ensuring all patients receive high-quality, guideline-concordant care.
  • Antithrombotic Therapy in Patients With AF and CCD: Evidence-based practice to improve outcomes.
  • Inappropriate Prescription of Flecainide or Propafenone for Patients With AF: Important for patient safety, to minimize risk of worsening HF, proarrhythmia, and increased mortality.
  • Inappropriate Prescription of Dronedarone for Maintenance of Sinus Rhythm or Ventricular Rate Control for Patients With AF: Important for patient safety to minimize risk of worsening HF and increased mortality.
  • Inpatient Initiation of Dofetilide for Patients With AF: Important for patient safety to minimize risk of torsades de pointes when dofetilide therapy is initiated and to align with how dofetilide was initiated in clinical trials.
  • Catheter Ablation for Patients With Symptomatic AF or AFL: Catheter ablation is an evidence-based therapy that improves rhythm control and quality of life but remains underutilized in eligible patients.
  • Periprocedural Oral Anticoagulation for Patients Undergoing Catheter Ablation for AF: Evidence-based practice that has been demonstrated to reduce the risk of peri-procedural stroke and bleeding.
  • AF Rhythm Control in Patients With HFrEF: Important for patient safety to minimize risk of worsening HF and improve survival outcomes.
  • Catheter Ablation for Patients With AF and HFrEF: Strong evidence supports improved outcomes with ablation in HFrEF, but use remains inconsistent. This underscores the need for a dedicated measure to promote systematic evaluation and appropriate use.

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