Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction
Background Physician shortages and reimbursement changes have led to greater use of advanced practice providers (APPs). Prevalence of and outcomes associated with APP care following myocardial infarction are unknown. Methods and Results We examined outpatient cardiology or primary care visits within...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2018-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.008481 |
| _version_ | 1828858176591626240 |
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| author | Jennifer A. Rymer Anita Y. Chen Laine Thomas Judith Stafford Jonathan R. Enriquez Abhinav Goyal Eric D. Peterson Tracy Y. Wang |
| author_facet | Jennifer A. Rymer Anita Y. Chen Laine Thomas Judith Stafford Jonathan R. Enriquez Abhinav Goyal Eric D. Peterson Tracy Y. Wang |
| author_sort | Jennifer A. Rymer |
| collection | DOAJ |
| description | Background Physician shortages and reimbursement changes have led to greater use of advanced practice providers (APPs). Prevalence of and outcomes associated with APP care following myocardial infarction are unknown. Methods and Results We examined outpatient cardiology or primary care visits within 90 days post‐myocardial infarction among 29 477 Medicare‐insured patients aged ≥65 years from 364 hospitals in Acute Coronary Treatment Intervention Outcomes Network Registry. We compared medication adherence, all‐cause readmission risk, mortality, and major adverse cardiovascular events between patients seen by APPs versus physicians only. Overall, 11% of myocardial infarction patients were treated by an APP. Patients seen by APPs were more likely to have diabetes mellitus (37% versus 33%) and heart failure (20% versus 16%), be discharged to a nursing facility (21% versus 13%) and had more outpatient visits within 90 days post‐discharge (median 6 versus 5, P<0.01 for all) than those seen by physicians only. Adherence to evidence‐based medications (adjusted odds ratio, 0.98; 95% confidence interval, 0.89–1.08) and readmission risks (adjusted hazard ratio, 1.11; 95% confidence interval, 0.99–1.26) were similar between patients seen by APPs versus physicians only. Risks of 90‐day mortality (adjusted hazard ratio, 1.18; 95% confidence interval, 0.98–1.42) and major adverse cardiovascular events (adjusted hazard ratio, 1.06; 95% confidence interval, 0.90–1.23) were also similar between patients seen by APPs versus physicians only. Conclusions APPs were likely used to provide more frequent monitoring of high‐risk post‐MI patients. Medication adherence, readmission risk, mortality, and major adverse cardiovascular events did not differ substantially between patients seen by physician‐APP teams than those seen by physicians only. |
| first_indexed | 2024-12-13T01:51:31Z |
| format | Article |
| id | doaj.art-dd196257f3ab45679071e6eac9d232a8 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T01:51:31Z |
| publishDate | 2018-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-dd196257f3ab45679071e6eac9d232a82022-12-22T00:03:30ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-09-0171710.1161/JAHA.117.008481Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial InfarctionJennifer A. Rymer0Anita Y. Chen1Laine Thomas2Judith Stafford3Jonathan R. Enriquez4Abhinav Goyal5Eric D. Peterson6Tracy Y. Wang7Duke Clinical Research Institute Durham NCDuke Clinical Research Institute Durham NCDuke Clinical Research Institute Durham NCDuke Clinical Research Institute Durham NCUniversity of Missouri‐Kansas City School of Medicine Kansas City MOEmory University School of Medicine Atlanta GADuke Clinical Research Institute Durham NCDuke Clinical Research Institute Durham NCBackground Physician shortages and reimbursement changes have led to greater use of advanced practice providers (APPs). Prevalence of and outcomes associated with APP care following myocardial infarction are unknown. Methods and Results We examined outpatient cardiology or primary care visits within 90 days post‐myocardial infarction among 29 477 Medicare‐insured patients aged ≥65 years from 364 hospitals in Acute Coronary Treatment Intervention Outcomes Network Registry. We compared medication adherence, all‐cause readmission risk, mortality, and major adverse cardiovascular events between patients seen by APPs versus physicians only. Overall, 11% of myocardial infarction patients were treated by an APP. Patients seen by APPs were more likely to have diabetes mellitus (37% versus 33%) and heart failure (20% versus 16%), be discharged to a nursing facility (21% versus 13%) and had more outpatient visits within 90 days post‐discharge (median 6 versus 5, P<0.01 for all) than those seen by physicians only. Adherence to evidence‐based medications (adjusted odds ratio, 0.98; 95% confidence interval, 0.89–1.08) and readmission risks (adjusted hazard ratio, 1.11; 95% confidence interval, 0.99–1.26) were similar between patients seen by APPs versus physicians only. Risks of 90‐day mortality (adjusted hazard ratio, 1.18; 95% confidence interval, 0.98–1.42) and major adverse cardiovascular events (adjusted hazard ratio, 1.06; 95% confidence interval, 0.90–1.23) were also similar between patients seen by APPs versus physicians only. Conclusions APPs were likely used to provide more frequent monitoring of high‐risk post‐MI patients. Medication adherence, readmission risk, mortality, and major adverse cardiovascular events did not differ substantially between patients seen by physician‐APP teams than those seen by physicians only.https://www.ahajournals.org/doi/10.1161/JAHA.117.008481adherenceadvanced practice providersmyocardial infarctionnursingreadmission |
| spellingShingle | Jennifer A. Rymer Anita Y. Chen Laine Thomas Judith Stafford Jonathan R. Enriquez Abhinav Goyal Eric D. Peterson Tracy Y. Wang Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adherence advanced practice providers myocardial infarction nursing readmission |
| title | Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction |
| title_full | Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction |
| title_fullStr | Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction |
| title_full_unstemmed | Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction |
| title_short | Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction |
| title_sort | advanced practice provider versus physician only outpatient follow up after acute myocardial infarction |
| topic | adherence advanced practice providers myocardial infarction nursing readmission |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.008481 |
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