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Canadian Journal of Cardiology

THE EFFECT OF NURSE PRACTITIONER-LED CARE IN TERTIARY CARE ON HEALTH-RELATED QUALITY OF LIFE IN ADULT PATIENTS WITH ATRIAL FIBRILLATION- RESULTS OF A RANDOMIZED CONTROLLED TRIAL

      Background

      Atrial fibrillation (AF) is associated with significant morbidity, mortality & healthcare resource utilization. The prevalence of AF is increasing with an aging population, and timely access to specialized cardiovascular care is a concern. Nurse practitioner (NP)-led care may improve access and quality of care, but requires formal assessment. The purpose of this study was to assess the effect of NP-led care, compared to usual general cardiologist care on health-related quality of life (HRQOL) in patients with AF.

      Methods and Results

      We conducted a randomized controlled trial comparing NP-led care vs. usual care in patients referred to our tertiary cardiology centre for AF. Inclusion criteria: consenting adults with documented nonvalvular AF and ability to complete questionnaires. Exclusion criteria: referred for electrophysiology (EP) intervention, clinically unstable, or unable to attend follow-up. We randomized patients 1:1 prior to their first clinic visit. Intervention: NP care (history, physical exam, treatment plan, patient education, and follow-up at 3 and 6 months). Control (usual care): General cardiologist consultation and follow-up as per their usual practice. Primary outcome was difference in change in Atrial Fibrillation Effect on Quality of Life (AFEQT) scores at 6 months between groups. Secondary outcomes were: difference in change of EuroQOL EQ-5D-3L scores at 6 months, difference in composite outcomes of death from cardiovascular (CV) cause, hospitalizations and emergency department visits, and patient satisfaction measured by Consultant Satisfaction Questionnaire (CSQ) at 6 months (all compared between groups). We enrolled 150 patients; demographics were similar between groups, with an average age of 64 years, 62% males, and overall AFEQT baseline score of 66.45 +/- 4.86. NP-led care led to more rhythm monitoring and referrals made to EP. AFEQT scores, EuroQOL EQ-5D-3L, and CV outcomes were not different at 6 months. NP-led care showed higher patient satisfaction (CSQ Professional care [76.32 +/- 11.32 vs 65.75 +/- 15.45, p=0.0006]).

      Conclusion

      We found no difference between NP-led care and usual cardiologist care in AFEQT score at 6 months. NPs working to their full scope resulted in higher patient satisfaction with care compared to usual cardiologist care.