Filling a gap in the management of atrial fibrillation: The EHRA-PATHS project highlights what can be achieved with Euro

Key takeaways

• The majority of patients with atrial fibrillation (AF) have other medical conditions ('comorbidities') that can adversely impact their treatment and outcomes.
• The ESC's European Heart Rhythm Association (EHRA) coordinated the EHRA-PATHS project to improve the detection and management of comorbidities in older patients with AF, with funding from the European Union.
• A standardised approach to detecting and managing 23 AF-related comorbidities was developed and incorporated into a software tool.
• This tool is being assessed in a large trial across Europe, and results are expected to be presented at EHRA 2027 in April 2027. The consortium hopes to show improved identification and management of comorbidities in a cost-effective way.
• The EHRA-PATHS project has also provided important learnings on navigating the complex regulatory landscape to evaluate a software tool in Europe, which will serve both EU authorities and future investigators.

Sophia Antipolis, France - 30 September 2026: The EHRA-PATHS project has successfully highlighted the need for a structured, holistic approach to improve the management of co-existing medical conditions that impact the lives of patients with atrial fibrillation (AF).

AF is the most common sustained heart rhythm disorder worldwide and represents a growing public health challenge, particularly in older patients. AF affects almost 38 million people globally and its prevalence is predicted to double over the next 35 years as the population ages [1].

Patients with AF often have several other medical conditions including hypertension, heart failure, overweight, diabetes, sleep apnoea and chronic kidney disease. These comorbidities not only contribute to the arrhythmia itself but also negatively affect outcomes, for example, increasing the risk of stroke, major bleeding, hospitalisation or death.

In 2021, the ESC's European Heart Rhythm Association (EHRA) launched the EHRA-PATHS project. Scientific Coordinator, Professor Hein Heidbuchel, said: "Within EHRA, we recognised that the healthcare community lacks a standard approach to addressing comorbidities. EHRA-PATHS was one of the first major research projects where the ESC and EHRA took on a coordinating role. We felt that it was necessary to take the lead to improve the quality of care that patients with AF receive by bringing together experts from centres across Europe and involving partners from other specialties."

Over the last five years, the EHRA-PATHS project has received funding of €6 million from the European Union's Horizon 2020 research and innovation programme and has involved a consortium of 14 partners from 11 European countries. The main aims are to map comorbidities in AF, to define how comorbidities should be treated via integrated care pathways and to provide a software tool to guide implementation.

In the first part of the project, comorbidities in older patients (over 65 years) with AF were characterised using data from more than 22,000 patients in three large ESC/EHRA registries. The analyses confirmed the large burden of comorbidities, revealing an average of three comorbidities per patient. Next, current clinical practice was mapped and a gap analysis was performed, taking into account healthcare professionals' and patients' perspectives. In a survey of more than 300 EHRA members, wide variation in management practices and clinical priorities were noted, with a lack of integrated care models identified as a major barrier to referring patients to specialist services for AF comorbidities [2].

The next stage involved developing easy-to-implement care pathways for each of 23 AF-related comorbidities across categories including general risk factors, cardiology, respiratory medicine, endocrinology, nephrology and medications [3]. A standardised template was created for each pathway detailing a detection trigger, a confirmation step and a key performance indicator for how the comorbidity should be managed within a 6-month time frame. These care pathways were embedded into a dedicated EHRA-PATHS software tool to support structured comorbidity assessment during AF clinic visits [4]. First data showed that such is possible with an 18-minute time investment over 6 months. A large, cluster-randomised trial, led by Professor Michiel Rienstra, is ongoing across 50 study sites in 11 countries to assess whether the care pathways implemented in the tool do, in fact, lead to improved detection of comorbidities and implementation of management strategies.

In the context of EU Medical Device Regulation, important learnings related to studying the software tool in the trial were presented at ESC Congress 2026 by Professor Lien Desteghe, co-coordinator of EHRA-PATHS. Despite a seemingly unified European regulation, in reality, national interpretation and associated processes varied widely. The EHRA-PATHS investigators have provided feedback to the European authorities so that shortcomings can be addressed and a publication is being finalised to help other clinical investigators assessing software in a similar way.

October 2026 marks the official end of the EHRA-PATHS project, with the overall results of the trial results expected to be presented at EHRA 2027. "We may not have the trial results yet, but EHRA-PATHS has already been impactful in terms of highlighting comorbidities in AF as an important issue that requires an integrated approach," explained Professor Heidbuchel. "EHRA and ESC have shown that they can lead coordinated research in Europe. We have also learned to navigate a complex regulatory landscape. Most importantly, we hope that we can contribute to better and more uniform care of patients with AF. Come and see our results at EHRA 2027!"

ENDS