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

Am J Cardiol. 2016 Dec 15;118(12):1842-1846. doi: 10.1016/j.amjcard.2016.08.074. Epub 2016 Sep 15.

Abstract

Sustained growth in the arrhythmia population at Stanford Health Care led to an independent nurse practitioner-run outpatient direct current cardioversion (DCCV) program in 2012. DCCVs performed by a medical doctor, a nurse practitioner under supervision, or nurse practitioners from 2009 to 2014 were compared for safety and efficacy. A retrospective review of the electronic medical records system (Epic) was performed on biodemographic data, cardiovascular risk factors, medication history, procedural data, and DCCV outcomes. A total of 869 DCCVs were performed on 557 outpatients. Subjects were largely men with an average age of 65 years; 1/3 were obese; most had atrial fibrillation; and majority of subjects were on warfarin. The success rate of the DCCVs was 93.4% (812 of 869) with no differences among the groups. There were no short-term complications: stroke, myocardial infarction, or death. The length of stay was shortest in the NP group compared to the other groups (p <0.001). In conclusion, the success rate of DCCV in all groups was extremely high, and there were no complications in any of the DCCV groups.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulatory Care / methods*
  • Ambulatory Care / organization & administration
  • Anticoagulants / therapeutic use
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / therapy*
  • Cardiomyopathies / epidemiology
  • Comorbidity
  • Diabetes Mellitus, Type 2 / epidemiology
  • Electric Countershock / methods*
  • Female
  • Humans
  • Hypertension / epidemiology
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Nurse Practitioners*
  • Obesity / epidemiology
  • Patient Safety
  • Physicians
  • Practice Patterns, Nurses'*
  • Retrospective Studies
  • Stroke / etiology
  • Stroke / prevention & control
  • Treatment Outcome
  • Warfarin / therapeutic use

Substances

  • Anticoagulants
  • Warfarin