Advanced Practice Provider Versus Physician-Only Outpatient Follow-Up After Acute Myocardial Infarction

• Type of Material: Article
• Authors: Jennifer A. Rymer, Duke Clinical Research Institute; Anita Y. Chen, Duke Clinical Research Institute; Laine Thomas, Duke Clinical Research Institute; Judith Stafford, Duke Clinical Research Institute; Jonathan R. Enriquez, University of Missouri; Abhinav Goyal, Emory University; Eric D. Peterson, Duke Clinical Research Institute; Tracy Y. Wang, Duke Clinical Research Institute
• Language: English
• Date: 2018-09-04
• Publisher: Wiley Open Access: Creative Commons Attribution Non-Commercial
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.117.008481
• Title of Journal or Parent Work: Journal of the American Heart Association
• ISSN: 2047-9980
• Volume: 7
• Issue: 17
• Start Page: e008481
• End Page: e008481
• Grant/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).
• Keywords: myocardial infarction; Cardiovascular System & Cardiology; advanced practice providers; PRIMARY-CARE; Science & Technology; Life Sciences & Biomedicine; adherence; readmission; MORTALITY; CLAIMS DATA; ADHERENCE; Cardiac & Cardiovascular Systems; NURSE-PRACTITIONERS; nursing
• Research Categories: Health Sciences, General

Abstract

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.