Assessment of post-percutaneous coronary intervention (post-PCI) ambulatory patient care revealed that advanced practice providers (APPs) provided the same quality of care as cardiologists or physician providers (PPs), with a lower cost of care associated with APPs, according to study results published in the Journal of Nurse Practitioners.
Researchers conducted a retrospective study at a rural tertiary care center of patients admitted to the cardiology service for a new cardiac diagnosis who followed-up with either a cardiologist or an APP. The study included 703 patients who underwent successful PCI for any indication from January to December 2011. Clinical outcomes included all-cause mortality, major adverse cardiac events, and readmission rates compared between groups for 1 year.
The APP and PP groups consisted of 144 and 164 patients, respectively (mean age, 66 years). More patients with hypertension, prior myocardial infarction, and prior PCI were in the APP group. The APP group had more patients with unstable angina and a lower proportion of patients who presented with ST-elevation myocardial infarction and those who received a bare metal stent at index PCI. The PP group had a higher percentage of patients who used beta-blockers.
At 12-month follow-up, major outcomes were not significantly different between the PP and APP groups (major adverse cardiac events, 12% vs 13%, respectively; cardiac readmission rate, 24% vs 23%, respectively; overall readmission rate, 34% vs 32%, respectively; all-cause mortality, 3% vs 6%, respectively).
In unadjusted analysis, the mean cost of cardiac care was significantly lower in the APP group ($1432) compared with the PP group ($1642).
“In this single-center, retrospective study, there were no significant differences with regard to quality of care provided by APPs compared with PPs in post-PCI ambulatory patients in unadjusted as well as propensity matched analysis,” the investigators concluded.
Mishra A, Arora S, Joshi D, Acker W, Kaluski E, Stapleton D. Assessment of post-percutaneous coronary intervention ambulatory care by advanced practice providers. J Nurs Pract. 2019;15(7):511-516.