Although the nurse practitioner (NP) population in cardiovascular (CV) care is growing, there are limited high-quality studies that provide evidence on the benefit of NP-led CV care, according to research findings published in the Journal of Advanced Nursing.
A team of Canadian researchers conducted a systematic review and meta-analysis of published and unpublished randomized control trials related to NP-led CV care and care outcomes between January 2007 and July 2017. Studies included patients >18 years of age with a diagnosis of CV disease who were randomly allocated to either NP-led care or another CV provider care (usually a physician).
Identified outcomes included change in symptoms, change in monitored risk factor reduction variables (blood pressure, cholesterol level), healthcare system quality improvement (wait time, length of stay), and patient-reported responses such as quality of life and patient satisfaction.
A total of 5 studies were included (2 from Canada, 2 from the United States, and 1 from The Netherlands); sample sizes varied and ranged from 48 to 330 total patients. NP interventions included assessment of vital signs, pain management, assessment of signs of heart failure and adjustment of medications as required, patient teaching related to disease conditions and recovery, and assessment of CV risk factors and treatment as indicated.
No statistical difference was found between NP-led care and usual care for 30-day readmissions, health-related quality of life, and length of stay. However, compared with the CV provider-led group, the NP-led group had a 12% decrease in the risk of developing coronary heart disease over the next 10 years. A total of 18.4% of patients in the NP-led group reached low-density lipoprotein cholesterol target levels and 19% stopped smoking.
“While incorporating NPs into CV care has been welcome, little is known about the outcomes of care,” stated the investigators. “Our review of the available evidence shows there is no significant impact (either positive or negative) on patient outcomes. It is extremely important for further high-quality research to be conducted to identify clinical outcomes of care associated with NP-led CV care as a model of care.”
Smigorowsky MJ, Sebastianski M, Mcmurtry MS, Tsuyuki RT, Norris CM. Outcomes of nurse practitioner-led care in patients with cardiovascular disease: a systematic review and meta-analysis [published online October 7, 2019]. J Adv Nurs. doi:10.1111/jan.14229