Background: Atrial fibrillation (AF) significantly impacts the clinical and financial burden of healthcare systems worldwide. Patient-reported outcomes (PROMs) are considered a core element of patient-centered care. However, the integration of PROMs into AF clinical pathways remains limited. Objectives: In this study, we aimed to develop a policy-oriented framework for integrating PROMs into AF management, building on QoL assessment and the AF-CARE pathway. Methods: We compared the selected instruments (AFEQT, SF-36, EQ-5D, and AFSS) to examine how different QoL domains are represented. We then considered how the missing domains relate to routine care and healthcare delivery. On this basis, we constructed a conceptual framework linking PROM domains with clinical and policy decisions, as well as with diagnostic and follow-up strategies in AF. Results: Existing PROMs capture symptom burden reasonably well, but they do not fully reflect several domains that shape the daily experience of patients with AF, including cognition, sleep quality, sexual health, and economic burden. The proposed framework places PROMs within the AF-CARE components and illustrates how they can be used in routine practice—not only for long-term monitoring, but also to improve clinical decision-making, and better align with value-based healthcare strategies at both the clinical and system levels. It also outlines a practical approach to incorporating PROMs into everyday care and into broader health-system decision-making. Conclusions: Integrating PROMs into AF-CARE requires a system-level redesign rather than isolated tool implementation. Within the proposed framework, the question is no longer whether PROMs should be used in AF care, but how to integrate them in a way that meaningfully influences clinical decisions and patient outcomes.

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.

Persistent atrial fibrillation (AF) is associated with complex structural, electrical, and functional myocardial remodeling that contributes to impaired cardiac performance, symptom burden, and adverse cardiovascular outcomes. Although restoration of sinus rhythm through electrical cardioversion remains a cornerstone of rhythm-control therapy, treatment success is traditionally defined by rhythm maintenance and recurrence rates, while myocardial functional recovery receives substantially less attention. This review aims to summarize current evidence regarding myocardial dysfunction in persistent AF, evaluate available approaches for assessing myocardial recovery after cardioversion, and explore future directions for function-guided rhythm-control strategies. A narrative review of contemporary literature was performed, focusing on studies published in major cardiovascular journals and current international guidelines. Evidence regarding myocardial remodeling, reverse remodeling after restoration of sinus rhythm, echocardiographic assessment, myocardial strain imaging, biomarker dynamics, and post-cardioversion management strategies was synthesized and critically evaluated. Persistent AF induces multidimensional myocardial dysfunction through tachycardia-mediated injury, structural remodeling, neurohormonal activation, inflammation, and fibrosis. Emerging evidence suggests that restoration of sinus rhythm may initiate a process of reverse remodeling characterized by improvements in left ventricular systolic function, global longitudinal strain, atrial mechanical performance, and biomarker profiles. Advanced echocardiographic techniques and serial biomarker assessment provide valuable opportunities to quantify myocardial recovery beyond conventional rhythm-based endpoints. However, current clinical practice and guideline-directed management remain predominantly focused on rhythm outcomes, while functional recovery is not routinely incorporated into therapeutic decision-making. Based on available evidence, a conceptual framework termed the “Post-Cardioversion Functional Window” is proposed to describe a period of potentially enhanced myocardial recovery during which systematic functional assessment may facilitate individualized management and future risk stratification. Myocardial recovery after restoration of sinus rhythm represents an underrecognized component of contemporary AF management. Integration of echocardiographic, biomarker-based, and clinical functional assessment may improve understanding of post-cardioversion remodeling and support the development of personalized rhythm-control strategies. Future prospective studies are needed to validate myocardial recovery endpoints and determine their role in guiding therapeutic decisions after cardioversion.

Objective: Remote consultations are quickly emerging to give more access to real-time, high-quality, efficient, and cost-effective healthcare in the current COVID-19 pandemic. Objective is to investigate the changing experiences of remote consulting for patients in Latvia and plan effective health policies, to provide a full analysis of the policy for telemedicine applications and solutions based on the current conditions. Design and method: Materials and approaches include an examination of normative documents as well as a variety of informational sources. The information offered is mostly based on national strategy papers, official reports, and scientefic publications on Tele-medicine implementation. Results: Telemedicine’s range will continue to expand, connecting patients and providers internationally as providers look to expand globally. This will not only help improve the long-term policies about health but may also provide patients with rare diseases alternative avenues to seek highly specialized care. Telemedicine strategy must react faster than ever during the COVID-19 epidemic. Latvia has reacted to Covid pandemics and have noticable implemented new possibilities to provide new approaches provided by telemedicine: providing remote consutlations to patients in different sectors, using E-referrals that were implemented but not sufficiently used before, providing more possibilites to provide remote services also for consiliums, physician-physiscan online consultations. New ICT tools were used for patient remote monitoring. The normative regulation, stategical decisions and changes in long-term policy documents haven’t been changed, so there are limitations to provide the telemedice expansion or stable use after the emengency situation ends. Health policies about telemedicine have another key role with to pursuing that. Conclusions: Telemedicine is fast expanding, demand for this service is rising. Although not a replacement for face-to-face consultations, this study illustrates that remote consulting can be an acceptable adjunct to traditional face-to-face consultations. More research is required to identify overall safety and applicability. Digital Health Strategy in Latvia is still on developing stage. Changes or legislation to clarify Telemedicine are still in the process. It is important to provide a good environment for Telemedicine to expand, setting strategies and visions on how those new approaches will be regulating normatively and administratively.