Effectiveness and Safety of an Independently Run Nurse Practitioner Outpatient Cardioversion Program (2009 to 2014)

Area of Science:

• Cardiology
• Nursing Practice
• Health Services Research

Background:

• Increasing arrhythmia patient volumes necessitated innovative care models.
• Stanford Health Care established an independent nurse practitioner-run outpatient direct current cardioversion (DCCV) program in 2012.
• Evaluating the safety and efficacy of DCCV across different provider groups is crucial for optimizing patient care.

Purpose of the Study:

• To compare the safety and efficacy of direct current cardioversion (DCCV) procedures performed by medical doctors versus nurse practitioners (NPs).
• To assess outcomes in an independent nurse practitioner-run outpatient DCCV program.
• To analyze biodemographic data, cardiovascular risk factors, and procedural outcomes for DCCV patients.

Main Methods:

• Retrospective review of electronic medical records (Epic) from 2009-2014.
• Inclusion of biodemographic data, cardiovascular risk factors, medication history, and procedural data.
• Comparison of DCCV outcomes among procedures performed by medical doctors, supervised NPs, and independent NPs.

Main Results:

• A total of 869 DCCVs were performed on 557 outpatients, predominantly male, average age 65, with atrial fibrillation.
• The overall success rate for DCCV was high at 93.4% with no significant differences observed between provider groups.
• No short-term complications such as stroke, myocardial infarction, or death were reported; length of stay was shortest in the NP group.

Conclusions:

• Outpatient direct current cardioversion (DCCV) is a highly successful and safe procedure regardless of provider.
• Independent nurse practitioner-led DCCV programs are effective and efficient, potentially reducing length of stay.
• The findings support the expansion and integration of advanced practice providers in managing arrhythmia care.