In the last several years, hospitals and heart centers are turning to advanced practice providers to improve patient access and ease physician workloads.
“In a time when patient access to cardiology care is limited by the number of cardiologists, APPs have been essential to maintaining this access,” Atizazul Mansoor, MD, chair of the Heart and Vascular Institute at UPMC in Central Pennsylvania, told Becker’s. “By increasing access to cardiac care, the presence of APPs positively impacts outpatient wait times for follow up, length of hospital stays and outcomes due to receiving more timely care.”
MedAxiom’s 2025 “Cardiovascular Advanced Practice Provider Compensation and Utilization Report” found cardiology APPs perform tasks such as rounding, admissions, consults, direct patient care management, night coverage, procedures and bed management. The average cardiology program had between six and seven APPs for every 10 physicians.
APPs have been a part of cardiology teams for years, but more systems are actively expanding their APP teams.
For example, Peoria, Ill.-based OSF HealthCare added a cardiology track to its Advanced Practice Provider Fellowship program. The new outpatient cardiology track will include rotations across cardiology subspecialties in urban and rural settings across Illinois, with hands-on training supported by the Jump Trading Simulation & Education Center.
Some systems are also investing in APP education and specialty collaboration to optimize care delivery.
“We are now using APPs who have developed the clinical and administrative skills to take on roles that were previously held exclusively by cardiologists — and in many cases this collaborative care model better positions future team based cardiology care models,” Jane Linderbaum, CNP, co-vice chair of Mayo Cardiovascular Outpatient Practice and associate professor of medicine at Mayo Clinic, told Becker’s.
“From a metric perspective, that partnership is also more cost-effective: Rather than deploying two subspecialists to develop a program, you partner one subspecialist with an APP, and the outcome will be scaleable, sustainable, and deliver faster high quality patient care” she said.
Here is how APPs are impacting cardiology programs across three heart centers.
Heart and Vascular Institute at UPMC in Central Pennsylvania
The Harrisburg, Pa.-based institute has had a stable APP staffing model for years that has expanded the pool of APP providers as the physician team grows. They maintain a staffing ratio of one APP for every two physicians,
APPs mimic the physician schedule, spending their days in the hospital rounding on patients and doing inpatient consults. They also do follow-ups and cover some procedural floor services including interventional, electrophysiology and structural heart, Dr. Mansoor said. The institute is looking to further expand patients’ access to APP care.
“As patients become more comfortable with the excellent, supervised care APPs provide, we see them fitting into a co-manage, longitudinal care paradigm,” Dr. Mansoor said. “In this way, we hope to expand the opportunity for new patients to be able to schedule their consultations with a cardiologist. Further, as the complexity of cardiac care increases, APPs will be an essential part in the education of our patients, so they, the patients, can be equal participants in their care decisions.”
Mayo Clinic
The Rochester, Minn.-based system has been utilizing APPs in cardiology since 1997.
“We hired and trained nurse practitioners and physician assistants alongside world-expert cardiologists to care for our sickest patients in the acute care setting,” Ms. Linderbaum said. “We learned that training APPs collaboratively with cardiologists who were skilled and invested in that training produced a postgraduate education consistent with expert care delivery — and it translated into shorter lengths of stay, improved patient satisfaction, enhanced resident education, and improved physician subspecialty satisfaction with the hospital practice. This collaborative model rapidly provided a framework for practices across Mayo Clinic.”
In the last eight years, APPs in inpatient and outpatient cardiac care have grown 50%. APPs are an embedded member of the care team and practice on focused chronic disease management, helping patients achieve guideline-directed-medical therapy goals, improve home management and decreasing hospital readmissions. Notably, all APPs and cardiologists are salaried, which allows them to dedicate the necessary time and focus to the most complex patients.
Care models that include cardiologists and APPs consistently score high in patient satisfaction and patient experience. The top 10% of individual providers across cardiology consistently include APPs. Mayo cardiologists are actively seeking practice models with APPs, Ms. Linderbaum said.
“We know that if APPs are seeing patients five days a week without variety, burnout is real, and it happens within a few years,” Sara Severson, DNP, APRN, cardiovascular NPPA director and assistant professor medicine at the system, told Becker’s. “Having variety — care team models, care coordination, involvement in research, practice initiatives, and education — is essential. The variety matters, and it’s not something you can overlook in sustaining a healthy APP workforce and designing team-based models of the future.”
VCU Health Pauley Heart Center
In 2005, just two APPs worked at the Richmond, Va.-based center’s cardiac surgery intensive care unit. Now, APPs are supporting general cardiology, heart failure and electrophysiology, as well as cardio‑oncology, cardio‑obstetrics and adult congenital heart disease specialists. In early 2025, VCU Health hired Paula Brooks, DNP, as the health system’s first associate vice president of advanced practice providers to oversee the growing workforce.
In the heart center’s outpatient clinic, the APP team has grown rapidly, from four in 2020 to 27 now, with more roles in the pipeline. The additional providers have allowed Pauley’s cardiology clinic to grow by 60% in six years.
APPs work closely with physicians to provide care, with physicians focused on more complex cases and APPs managing routine and moderate-complexity care. APPs are also training to perform cardioversions and loop recorder implantations, which previously required a physician, according to the release.
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