Do Advanced Practice Nurses or Physician Assistants Outperform Cardiologists?

Abstract

I read with interest the analysis from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE-HF) program by Albert et al. 1 Albert N.M. Fonarow G.C. Yancy C.W. Curtis A.B. Gattis Stough W. Gheorghiade M. Heywood J.T. Mcbride M. Mehra M.R. O'Connor C.M. Reynolds D. Walsh M.N. Outpatient cardiology practices with advanced practice nurses and physician assistants provide similar delivery of recommended therapies (findings from IMPROVE HF). Am J Cardiol. 2010; 105: 1773-1779 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar The investigators suggested that having ≥2 advanced practice nurses (APN) or physician assistants (PAs) in cardiology practices was associated with greater use of implantable cardioverter-defibrillator therapy and delivery of heart failure education compared with practices with no APNs or PAs. The significant association of having ≥2 APNs or PAs with heart failure clinic, however, questions the generalizability of this finding. The investigators need to ensure that this finding is not heavily influenced by APNs or PAs practicing in heart failure clinics. The reader gets the impression that the findings apply to cardiology outpatient practices at large. To reach that conclusion, this association should be demonstrated in cardiology practices not associated with heart failure clinics; otherwise, the findings would more accurately reflect the performance of heart failure clinics. Outpatient Cardiology Practices With Advanced Practice Nurses and Physician Assistants Provide Similar Delivery of Recommended Therapies (Findings from IMPROVE HF)American Journal of CardiologyVol. 105Issue 12PreviewNational guidelines recommend a team model of care to facilitate adherence to evidence-based practices; however, previous studies suggesting benefit may have limited generalizability. The aim of this study was to examine the influence of advanced practice nurse (APN) and physician assistant (PA) staffing on the delivery of guideline-recommended therapies for outpatients with heart failure (HF). The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF), a prospective cohort study, enrolled 167 cardiology practices to characterize outpatient management of 15,381 patients with chronic HF and left ventricular ejection fractions ≤35%. Full-Text PDF