TY - JOUR
T1 - Advanced practice provider versus physician-only outpatient follow-up after acute myocardial infarction
AU - Rymer, Jennifer A.
AU - Chen, Anita Y.
AU - Thomas, Laine
AU - Stafford, Judith
AU - Enriquez, Jonathan R.
AU - Goyal, Abhinav
AU - Peterson, Eric D.
AU - Wang, Tracy Y.
N1 - Funding Information:
This study was funded by the Agency for Healthcare Research and Quality through a Centers for Education and Research on Therapeutics grant (U19HS021092).
Funding Information:
All statistical analyses were performed using SAS software (version 9.4, SAS Institute). The Duke Clinical Research Institute conducted all analyses. This project was supported by a grant from the Agency for Healthcare Research and Quality (U19H2O21092).
Publisher Copyright:
© 2018 The Authors.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - 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.
AB - 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.
KW - Adherence
KW - Advanced practice providers
KW - Myocardial infarction
KW - Nursing
KW - Readmission
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U2 - 10.1161/JAHA.117.008481
DO - 10.1161/JAHA.117.008481
M3 - Article
C2 - 30371165
AN - SCOPUS:85054501178
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 17
M1 - e008481
ER -