Outcomes of Nurse Practitioner Led-Care in Adult Patients with Atrial Fibrillation

Abstract

Atrial fibrillation is the most common arrhythmia and is increasing in prevalence worldwide. While it is not acutely life threatening, the complications of stroke and heart failure carry high mortality rates and extensive healthcare costs. Healthcare leaders have identified the extra demands these places on an already overwhelmed healthcare system and thus new models of care are being assessed. Nurse practitioners are graduate prepared, independent healthcare providers who have a scope of practice, which includes, patient history and physical assessment, ability to diagnose, order diagnostic testing and determine a treatment care plan. They also have prescriptive authority. Thus, utilizing nurse practitioner-led care may be an effective way to improve access to care and patient reported outcomes. This thesis is focused on identifying the benefits of cardiovascular nurse practitioner-led care.This thesis includes two studies. Study number one is a systematic review and meta-analysis to assess randomized controlled trial evidence determining the impact of nurse practitioner-led care. Our initial search identified 605 potential articles however, only five studies met the inclusion criteria. While none of the five studies reported a statistical difference in health related quality of life and length of stay. Between nurse practitioner-led care and usual care for 30-day readmissions, the limitations of the studies did not provide conclusive evidence of appropriate models of care for patients with atrial fibrillation. Therefore the second study is a randomized control trial assessing the effect of nurse practitioner-led care on health-related quality of life in adult patients with atrial fibrillation. The study is currently ongoing, with a projected end date of December 31, 2019. We have completed an interim analysis for the purposes of this study