Nowadays many areas in medicine are covered by allied professionals usually supervised by a medical specialist. This holds especially for areas in which care and cure are highly standardised, deviations from the planned track not expected and risk of complications low. One such area is cardioversion of atrial fibrillation (AF). The management of AF is complex and costly and adherence to guideline recommendations is frequently not up to the mark. Work-up before interventions such as cardioversion may be improved by installing clinical pathways led by nurse practitioners or physician assistants. Deuling et al. report in the present issue of the Journal that the number of avoidable postponements of cardioversion reduced significantly after changing physician-led to nurse-led cardioversion [
1]. The new pathway appeared to be safe. However, time to cardioversion did not shorten with nurse-led care. The majority of patients followed their pathway as planned whatever the type of care applied. Also, logistical steps other than checking anticoagulation may need optimisation. In addition, unavoidable obstacles hampering smooth nurse-led care also played a role on the road to cardioversion, including new atrial thrombus, hospital admissions and personal circumstances [
1]. …
