Integrating Patient-Reported Outcomes into Atrial Fibrillation Care Pathways: Implementation Challenges, Health System Implications, and Future Directions

Background/Objectives: Atrial fibrillation (AF) imposes a substantial long-term clinical and healthcare system burden, recurrent hospitalizations, impaired quality of life, and increasing long-term healthcare costs. Although patient-reported outcome measures (PROMs) are increasingly used in AF research and clinical practice, their broader role in healthcare delivery, implementation, and system-level decision-making remains insufficiently defined. Existing assessment strategies frequently prioritize symptom burden while underrepresenting cognitive, emotional, social, and functional dimensions of AF-related impairment. This narrative implementation review examines the current role of PROMs in AF management from a healthcare system and implementation perspective. Methods: Literature addressing AF-specific and generic PROM instruments, implementation strategies, health system integration, value-based care, and digital health approaches was reviewed and synthesized across PubMed, Scopus, and Google Scholar. Particular emphasis was placed on implementation barriers, workflow integration, evidence strength, and challenges encountered across diverse healthcare settings. Results: Current PROM frameworks incompletely capture several important dimensions of AF burden, including cognitive dysfunction, sleep disturbance, emotional distress, social participation, sexual health, and productivity loss. Beyond conventional symptom assessment, PROMs may support longitudinal patient monitoring, treatment evaluation, shared decision-making, and patient-centred care. Emerging evidence also suggests potential roles in outpatient prioritization, healthcare quality assessment, and value-based healthcare initiatives, although prospective AF-specific implementation studies remain limited. Mapping PROM applications to the 2024 ESC AF-CARE pathway demonstrates the strongest alignment with the Evaluation and Reducing symptoms domains while supporting patient engagement, comorbidity management, and individualized care planning. Implementation remains constrained by clinician workload, questionnaire fatigue, limited interoperability, heterogeneous digital infrastructure, and variability in organizational resources, with these challenges potentially being more pronounced in smaller or resource-limited healthcare systems. Conclusions: PROM integration in AF care may provide opportunities to strengthen patient-centered management and improve healthcare system responsiveness beyond conventional rhythm- and symptom-focused approaches. Successful implementation may require careful adaptation to local healthcare infrastructure, workflow feasibility, and long-term sustainability. Future developments involving digital platforms, wearable technologies, and artificial intelligence-assisted interpretation may further expand the clinical and operational relevance of PROM-guided AF care.