Heart disease patients appear to get comparable care whether they see a doctor, nurse practitioner or physician assistant, a new study finds.
But most outpatient cardiac care fails to meet established standards for good heart health management, regardless of the provider, the researchers determined. Just over 10 percent of providers complied with all of the current recommendations, the study revealed.
Many patients aren’t getting the care they need, said Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles.
“As a result [they] may be at risk for cardiovascular events and deaths that could have been prevented,” added Fonarow, who wasn’t involved in the study.
The researchers, led by Dr. Salim Virani, a cardiologist at the DeBakey Veterans Affairs Medical Center in Houston, based their results on more than 600,000 heart patients cared for in 2012.
The findings appear in the Oct. 12 issue of the Journal of the American College of Cardiology.
Because of its aging population and current retirement trends, the United States will experience a substantial doctor shortage in coming years, according to the Association of American Medical Colleges.
It anticipates a shortfall of 45,000 primary care doctors and 45,000 specialists by 2020.
That concern has placed a spotlight on the potential of nurse practitioners and physician assistants to help fill the gap.
According to the American Association of Nurse Practitioners, certified nurse practitioners complete training that goes significantly beyond that of a registered nurse. Although state regulations vary, in general nurse practitioners are qualified (either on their own or in consultation with a physician) to provide diagnostic services, manage patient care and prescribe treatments and medications.
Similarly, under doctors’ supervision (and with similar state restrictions), certified physician assistants can conduct physical exams and provide diagnostic services, counseling and treatment plans.
For the new study, the researchers reviewed patient data gathered by an American College of Cardiology electronic health registry.
Patients had received care from one of more than 1,200 providers at one of 90 practices across the country. About 70 percent were treated at facilities that had both physicians and so-called “advanced practice providers” on staff. The rest had only physicians.
The study authors first compared the quality of heart care provided by doctors versus their non-doctor counterparts in facilities staffed with both. A second analysis compared heart care provided by doctor-only facilities versus care from nurse practitioners/physician assistants in facilities with both.
Only about 12 percent of either doctors or nurse practitioners/physician assistants were found to meet all heart care standards with regard to basic screening and treatment protocols.
These guidelines include ensuring use of beta-blocker drugs by anyone with a prior heart attack; prescribing anti-platelet medications and effective cholesterol control; and use of anti-clotting drugs in patients with a history of irregular heartbeat (atrial fibrillation). Health care providers should also make referrals to cardiac rehabilitation and encourage smokers to quit, according to the guidelines.
The study authors found very little difference between doctors and nurse practitioners/physician assistants in terms of care quality, even after accounting for patients’ age, gender, insurance status, and frequency of visits.
Dr. Paul Heidenreich, a professor of medicine at Stanford University, co-authored an accompanying journal editorial. He said, “The findings confirm prior studies that show that advanced practice providers such as physician assistants and nurse practitioners can do as well or better than physicians at delivering simple but important care such as education, smoking cessation counseling, ordering cancer screening tests and vaccinations.”
His co-author, Dr. Robert Harrington, chair of the department of medicine at Stanford, added that the study finding is important “as the population ages and there are insufficient numbers of M.D.’s available for all patients for every encounter.”
But Harrington and Heidenreich also expressed disappointment at the poor standard of overall care.
Fonarow added that more studies are needed to assess patient outcomes, satisfaction and value.
See what heart outpatients need to know at the American College of Cardiology.
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