Outcomes of nurse practitioner-led care in patients with cardiovascular disease: A systematic review and meta-analysis.
Marcie J Smigorowsky, Meghan Sebastianski, Michael Sean McMurtry and 2 others
PMID 31588598WHAT IT FOUND
Nurse practitioner-led cardiovascular care showed no clear difference from usual care in heart failure readmission, hospital stay after surgery, quality of life, or vascular risk.
The finding came from five small trials.
Key findings
01Across the pooled trials, nurse practitioner-led cardiovascular care did not significantly reduce 30-day heart failure readmission or length of stay after cardiac surgery compared with usual care.
02Nurse practitioner-led care did not significantly change SF-36 physical or mental composite quality-of-life scores compared with usual care.
03Adjusted Framingham change was -12% (-22% to -3%) with nurse practitioner-led care and -8% (-18% to 2%) with usual care, and the review found no statistically significant difference for any outcome.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only five randomized trials met the inclusion criteria, so the review has very few data points. Sample sizes were small, ranging from 48 to 330 patients per trial. Included trials were low to moderate quality, with risk of bias from randomization issues and unclear intervention details. Blinding of participants and care providers to nurse practitioner-led care was not possible, and the review did not count this as risk of bias. The vascular risk reduction result came from one trial, so it cannot be pooled or treated as firm evidence. The review searched only English articles and could not assess publication bias because few trials were included.
Declared interests
No conflict of interest has been declared by the authors.
The easy way to misread this
Do not read the -12% Framingham change as proof that nurse practitioner counselling alone lowers risk. It came from one internet-based risk management trial on top of usual care, with internist supervision, and the review found no statistically significant difference for any outcome.