The impact of a nurse-led elective direct current cardioversion in atrial fibrillation on patient outcomes: A systematic review

Abstract

Aims and objectives: To examine and present the success rate in relation to nurse-led elective DCCV service in AF patients.

Background: As the incidence of AF increases healthcare settings will continue to face challenges in providing appropriate timely intervention. The provision of DCCV has primarily been medical-led. Due to the increasing requirement of hospital beds, cost restriction and medical team stress the roles of nurse specialists have been driven to include elective DCCV.

Design: A systematic review with a narrative synthesis was undertaken.

Methods: The databases searched include the following: The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Embase, Clinical Key, Web of Science, Cochrane Library and HSE library website. A total of 187 articles were identified, and seven studies were included for synthesis. The EBL checklist was used to assess validity. The PRISMA checklist was used for transparency.

Results: The results of this review show an acceptable complication rate, no negative patient outcomes and a high rhythm conversion success rate. A disparity was identified due to the lack of distinction between registered nurse (RGN), advanced nurse practitioner (ANP), advanced practice provider (APP) and nurse practitioner (NP) roles. These results support the belief that a highly skilled nurse in this specific background working in a supportive organisational framework can make a valuable contribution to such practices.

Conclusion: A structured nurse-led elective DCCV service appears safe, effective and has a high success rate in restoration to sinus rhythm in AF. However, the need for further research in order to advance knowledge and support changes in nurse-led DCCV practice is evident.

Relevance to clinical practice: This review demonstrates that a nurse-led elective DCCV service appears safe and successful in restoring sinus rhythm. It has promising potential effects in terms of waiting time, cost saving and achieving patient satisfaction.

Keywords: atrial fibrillation and cardioversion; nurse-led cardioversion in atrial arrhythmias; nurse-led elective cardioversion in atrial fibrillation; nurse-led electrical cardioversion; nurse-led external cardioversion; nurse-run atrial fibrillation and DC cardioversion; nurse-run cardioversion services; nurse-run direct current cardioversion service.