Advanced practice providers ease physician workload in complex post-MI care
One in 10 myocardial infarction (MI) survivors receive team-based care from both a physician and an advanced practice provider (APP) in the weeks following their heart attack, according to a report published in the Journal of the American Heart Association—and the joint approach could improve quality of care for patients with complex comorbidities.
First author Jennifer A. Rymer, MD, MBA, and colleagues at Duke University said APPs—which include nurse practitioners and physician assistants—have been taking on a heavier workload in recent years as the U.S. physician workforce continues to dwindle.
“National practice changes in response to limited physician availability, scheduling inflexibilities, reimbursement considerations and other factors have resulted in more patients receiving care from advanced practice providers,” Rymer, a fellow in Duke’s advanced training cardiology program, and co-authors wrote in JAHA. “In current practice, frequently cited reasons for integrating APPs into clinical practices include resident duty hour restrictions and a need to improve continuity of care and timely patient access to care.”
Since the Association of American Medical Colleges estimates there will be a 90,000-plus physician deficit within two years, and the ACC estimates a shortage of 16,000 cardiologists by 2025, APPs have been filling in those gaps, providing care to patients where physicians physically can’t.
Some studies have suggested APPs provide the same level of care to patients as physicians, the authors said, which is one of the reasons 21 states and the District of Columbia permit nurse practitioners to practice independently. Rymer and her co-authors looked into how post-myocardial infarction care differed between physicians only and physician-APP teams, pulling data from the ACTION Registry and CMS claims to evaluate outpatient visits in nearly 30,000 Medicare-insured patients across 364 hospitals. The research focused on a 90-day period after patients’ heart attacks.
Rymer’s team found 11 percent of MI survivors were treated by an APP within three months of their heart attack, and those patients were more likely to be more clinically complex, have diabetes or heart failure, and be discharged to a nursing facility than those cared for by physicians only.
Adherence to medications, readmission risk, overall mortality and rates of major adverse cardiovascular events were similar among all study participants.
Rymer et al. said the findings were in line with their original hypothesis, which posited more medically complex patients might benefit from a physician-APP team where the physician would guide shared decision-making and the APP could ensure fluid care.
“Increasingly, hospitals, payers and policymakers are focusing on early outpatient follow-up post-discharge to reduce preventable readmissions,” the authors wrote. “The frequency of post-MI patients receiving outpatient care from APPs observed in our study underscores practice changes in the United States as a result of physician supply being outweighed by demand. APPs have become increasingly critical sources of care for MI patients, as well as in many other disease states.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.