Abstract 4368525: Feasibility of a Nurse Practitioner-led Interdisciplinary Virtual Clinic for Secondary Prevention in Stable Coronary Artery Disease

Abstract

Background: Virtual care offers a promising alternative to in-person visits for management of coronary artery disease (CAD). The aim of this study is to evaluate the feasibility of a nurse practitioner (NP)-led interdisciplinary virtual clinic dedicated to secondary prevention in stable CAD. Hypothesis: A NP-lead interdisciplinary virtual clinic will ensure patients receive recommended therapies and meet guideline-directed targets of therapy for secondary prevention of CAD. Methods A pilot feasibility study was conducted in an academic cardiology practice in an urban setting in Canada from July 2021 to July 2024. A convenience sampling of adults (age 18 and older) with diagnosis of stable CAD with normal LV function and stable symptoms were included. Video visits were conducted by the NP at minimum of one visit per year. Cases were reviewed with a cardiologist asynchronously. Primary outcomes: 1) percentage of patients receiving appropriate guideline-directed medical therapies (GDMT) and meeting treatment targets at 1-year vs baseline, 2) percentage of patients to successfully complete virtual visits at one year without need for in-person visit, and 3) patient satisfaction with the program using a post visit experience survey. Balancing measures included number of adverse events (hospitalization, unexpected MI or need for additional intervention). Results A total of 66 participants (mean age 66.6 years, 72.7% male) were enrolled in the virtual clinic; 43 patients completed a one year follow up and were included in the analysis. The percentage of patients on GDMT was not significantly different at baseline compared to one year follow up (Table 1). Although more patients at one year follow up met blood pressure and triglyceride targets compared to baseline, these trends were not significant (Appendix A). At one year, 64 participants (97%) were successfully evaluated virtually without need for in person visit. Only 1 participant experienced an adverse event during the study. Of the 58 participants (87.9%) who completed a survey, 91% were satisfied or very satisfied with their care and 77.6% reported their virtual visit experience was equal or better to in person visits. Conclusions A NP-led interdisciplinary virtual clinic is a feasible model to deliver secondary prevention for stable CAD. Further research is needed to better understand the efficacy of this intervention on improving GDMT and meeting targets of therapy in the long run.