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NPs, PAs Comparable to Physicians in Ongoing Cardiac Care

October 13th, 2016

HOUSTON – Is this statement true or false: Cardiac patients receive the best ongoing care when they see their doctors not advanced practice providers such as physician assistants and nurse practitioners.

The answer, according to a new study published in the Journal of the American College of Cardiology, is that the care for coronary artery disease, heart failure and atrial fibrillation is comparable, no matter which of those is providing care. None of the providers met all performances measures, however, according to the study led by researchers from the Michael E. DeBakey Veterans Affairs Medical Center in Houston.

Using the American College of Cardiology’s PINNACLE Registry, the researchers compared quality of coronary artery disease (CAD), heart failure, and atrial fibrillation care delivered by physicians and advanced practice providers (APPs) for outpatient visits between Jan. 1, 2012, and Dec. 31, 2012. Included in the study were 716 physicians and 167 APPs in 41 practices, caring for 459,669 patients.

The mean number of patients seen by APPs (260.7) was lower compared with that seen by physicians (581.2). Compliance with most CAD, heart failure, and atrial fibrillation measures was comparable, except that the NPs and Pas were more likely than physicians to urge smoking cessation screening and intervention (adjusted rate ratio: 1.14) and cardiac rehabilitation referral (rate ratio: 1.40) among CAD patients.

Yet none of the healthcare professionals had high compliance with all eligible CAD measures, according to the results, with 12.1% for APPs and 12.2% for physicians. The results didn’t vary when the 41 physician practices with APPs were compared to the 49 practices without.

“Apart from minor differences, a collaborative care delivery model, using both physicians and APPs, may deliver an overall comparable quality of outpatient cardiovascular care compared with a physician-only model,” study authors conclude.

"Our findings indicate that a collaborative care delivery model which employs both physicians and advanced practice providers appears to provide a care quality that is comparable to a physician-only model," lead author Salim S. Virani, MD, PhD, said in an American College of Cardiology press release.

"Our results also have health care policy implications," Virani points out. "It should be reassuring that the quality of care for uncomplicated outpatient cardiovascular disease is at least equivalent between advanced practice providers and physicians, even in states with independent scope of practice laws for advanced practice providers and between practices with both advanced practice providers and physicians compared with physician-only practices."

"I am uncertain that these findings can be generalized across the varied health systems of the United States," added Valentin Fuster, MD, PhD, editor-in-chief of the Journal of the American College of Cardiology. "However, I am certain that team-based delivery models will provide the basis of the highest quality care."