A Meta Analysis Study Outcomes Of Nurse Practitioner Led Care In Patients With Cardiovascular Disease A Systematic Rev 1 (54.92 KiB) Viewed 38 times
A Meta Analysis Study Outcomes Of Nurse Practitioner Led Care In Patients With Cardiovascular Disease A Systematic Rev 2 (51.43 KiB) Viewed 38 times
A META-ANALYSIS Study: Outcomes of nurse practitioner-led care in patients with cardiovascular disease: A systematic review and meta-analysis (Smigorowsky et al 2020) Purpose: The purpose of the systematic review was to assess the impact of nurse practitioner-led cardiovascular (CV) care on patient outcomes, as evaluated in trials that compared the nurse practitioner (NP) model of care to other care models (typically physician-led care). Eligibility Criteria: A primary study was considered eligible for the systematic review if it met the following criteria with PICO elements identifiedk (1) The study used an RCT design to assess the impact of NP-led CV care o versus CV care by another health care provider (0; (2) the participants in the trial had to be older than 18 years of age and diagnosed with a CV disease (PE (3) the outcomes of care (0) had be associated with NP-led care specific to the setting and research focus-outcomes such as symptoms (e2, angina), monitored risk factor reduction variables eg., blood pressure), health care system quality (eg, length of stay and patient-reported outcomes teg-quality of life and (4) the studies were published in English between 2007 and 2017 Search Strategy: A search for primary studies was undertaken in seven bibliographic databases te... CINAHL, MEDLINE EMBASE). Numerous search terms were used, including the MeSH terms cardiovascular disease atrial fibrillation, nurse practitioner, coronary artery disease, and hypertension, Additional seach methods were used, including ancestry searching with the assistance of a reference librarian. The reviewers Induded an appendix that detailed their full search strategy Sample: The analysis was based on a sample of 5 studies that met all eligibility criteria 2 from Canada 2 from the United States and 1 from the Netherlands, initially, 1.563 studies were identified in the electronic search, 958 of which were duplicates and removed. After reviewing titles another 539 studies were excluded, and a further 56 studies were removed after abstract reviews. The sample stres for the included studies ranged from 48 to 330 patients for a total of 887 patients Quality Appraisal: The reviewers used the Cochrane risk of bus approach for sex domains random sequence generation allocation concealment blinding of outcome assessmentation selective reporting and other bus. Studies were then categorized on whether they had low risk of buscat risk inrer to one domain, moderate risk at risk in two to three domains or high rok at risk in four to six domains). Overall, two studies were categorized as low risk two were moderate risk and one was his of blas
Data Extraction: Two reviewers independently extracted data: disagreements were resolved by consensus. The extracted data included publication Information, sample size, number of patients per group. CV care area: NP role; and associated outcomes of care. Identified outcomes for a meta- analysis included 30-day readmission rate for heart failure, length of stay after cardiac surgery, and patients' scores on a quality of life scale called SF- 36, which yields separate physical and mental health scores. One outcome (vascular risk reduction) was available in only one study and was not analyzed in a meta-analysis. Effect Size Calculation: Odds ratios were used as the effect size index for some outcomes (@gu 30-day readmission for heart failure), and Cohen's the standardized mean difference was used for other outcomes tegu tength of stay postsurgery, scores on the 57-36). Statistical Analyses: The researchers found evidence of significant statistical heterogeneity for one outcome mental health subscale scoress. They used a random effects model for their main analysis, in which the effect sizes were weighted by the study sample size. Because there were only five studies in the review, no subgroup analyses were undertaken Key Findings: There were no statistically significant differences in effect sizes for Nated care versus other CV care for 30 day readmissions. length of stay, and scores on the two quality of life subscales. For example, the mean difference for length of stay was -.89.950 C -2.440.66. In the narrative review of vascular risk reduction, the one available study found a 12 reduction in the Framinghamrisk score for NP:led care. The reviewers also used GRADE to assess confidence in the evidence in their appraisal, the quality of evidence was low for the absence of an e of an effect for 30-day readmissions, and moderate for other outcomes included in the meta-analysis. Discussion: The reviewers concluded that despite the rigorout search and analysis methods used in this systematic review the findings should be considered inconclusive because of the limited number of relevant primary studies and the moderate to high risk of basin all but two studies. They stated that ot is extremely important for further high-quality research to be conducted to identitydinical outcomes of care associated with Med CV care as a model of care
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