NURS FPX 8004 Assessment 4 Literature Review (2).docx

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1. NURS FPX 8004 Assessment 4: Literature
Review
Capella University
NURS-FPX8004
Professor Name
Date
Introduction
Pulmonary hypertension (PH) remains a significant global health concern that requires timely evaluation and
management. The present literature review addresses the following PICOT question:
“In patients with pulmonary hypertension (P), does early evaluation and guideline-based
treatment (I), compared with delayed evaluation and treatment (C), influence disease severity
and hospitalization rates (O) over a 12-month follow-up period (T)?”
To address this inquiry, a systematic literature review was conducted using PubMed, CINAHL, Scopus, and
MEDLINE databases. Peer-reviewed studies from 2020 to 2025 were included. The search strategy
incorporated key terms such as early evaluation, pulmonary hypertension, hospitalization rate, treatment
outcomes, and disease progression. Out of 412 identified articles, studies were screened based on criteria
including early intervention, hospitalization outcomes, and disease progression.
Findings consistently highlight that early diagnosis and treatment of pulmonary hypertension reduce disease
exacerbation, hospitalization rates, and improve long-term outcomes. These insights support the clinical and
public health value of adopting early diagnostic strategies.
Thematic Synthesis of Literature
Theme 1: The Impact of Delayed Diagnosis
Delayed diagnosis of pulmonary hypertension significantly affects patient outcomes, healthcare utilization,
and costs. Kubota et al. (2023) demonstrated that right ventricular dysfunction, detected via biomarkers
and echocardiographic assessments, is strongly associated with disease severity. Patients with delays
exceeding three months from symptom onset to diagnosis were more severely ill and classified as higher-
risk under ESC guidelines.
Didden et al. (2023) highlighted that the median diagnostic delay in the U.S. exceeds two years, with many
patients presenting with unexplained dyspnea before undergoing evaluation. Similarly, DuBreck et al. (2023)
found that diagnostic delays greater than 24 months were linked to higher hospitalization rates, ICU
admissions, and readmissions within one year, alongside increased healthcare costs. These findings
underscore the significant clinical and economic burden of delayed evaluation.
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Theme 2: Health Disparities and Socioeconomic
Determinants

2. Socioeconomic and racial disparities play a pivotal role in delayed PH diagnosis and treatment outcomes.
Dalton et al. (2024) revealed that patients from disadvantaged backgrounds, particularly Hispanic
populations, experienced higher hospitalization rates and mortality, often due to limited access to
specialized care. Ong (2020) similarly noted that patients from rural or low-income settings faced
disproportionately poor outcomes due to structural barriers.
Talwar et al. (2022) further observed reduced referral rates for Hispanic and African American patients,
resulting in delayed diagnosis and worsened outcomes. Bernardo and Perez (2023) confirmed that
underrepresented minority groups often presented at more advanced disease stages and demonstrated
lower survival rates, even with access to standard care. These studies highlight the urgent need to address
health disparities through equitable referral pathways, early screening, and improved access to care.
Theme 3: Clinical Predictors and Risk Stratification
Advancements in clinical tools have enhanced risk stratification in PH management. Vraka et al. (2023)
emphasized the utility of multiparameter models that integrate clinical, hemodynamic, and imaging data to
classify patients as low, intermediate, or high risk, facilitating targeted decision-making.
Celestin et al. (2024) highlighted the value of echocardiographic markers, such as right ventricular wall
strain, as reliable predictors of disease progression. Similarly, Sonnweber et al. (2023) demonstrated how
machine learning techniques can identify distinct PH phenotypes, offering pathways for personalized
treatment. Ghio et al. (2024) reinforced the predictive value of echocardiographic phenotyping in forecasting
outcomes and guiding long-term care.
Together, these findings reflect a shift toward precision medicine, with clinical predictors and advanced
imaging improving patient stratification and management strategies.
Recommendations for Future Research and
Practice
Future research should prioritize three interrelated areas: reducing diagnostic delays, addressing health
disparities, and advancing risk stratification models. Strategies must include the development of equity-
focused, standardized evaluation pathways to ensure timely diagnosis across diverse populations (Barwise et
al., 2021).
Educational initiatives for primary care providers should emphasize early recognition of symptoms,
expediting referrals for specialist evaluation. Moreover, healthcare systems should integrate socioeconomic
and environmental determinants of health into predictive models to improve generalizability and clinical
applicability (Flaubert et al., 2021).
Finally, the convergence of clinical data, epidemiology, and digital health technologies can generate
actionable insights to inform precision-based care, reduce disparities, and optimize long-term management
of pulmonary hypertension.
Conclusion
This literature review reinforces that early evaluation and intervention in pulmonary hypertension
significantly improve outcomes by reducing disease severity, hospitalizations, and healthcare costs.
Conversely, delayed diagnosis contributes to poor prognoses, higher utilization of acute care, and increased
mortality, particularly among socioeconomically disadvantaged and minority populations.
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3. Clinical predictors and advanced risk stratification tools are reshaping management approaches, guiding
personalized treatment strategies. Future directions must focus on equitable access, integration of social
determinants of health, and the adoption of predictive technologies to close gaps in care.
The evidence aligns with the premise that early, guideline-driven interventions are essential in mitigating
disease progression and improving survival in pulmonary hypertension patients.
References
Barwise, A., et al. (2021). [Reference details]. https://doi.org/10.1097/PTS.0000000000000817
Celestin, R., et al. (2024). [Reference details]. https://doi.org/10.1016/j.ccm.2023.03.010
Dalton, J., et al. (2024). [Reference details]. https://doi.org/10.1002/pul2.12361
DuBreck, A., et al. (2023). [Reference details]. https://doi.org/10.1002/pul2.70041
Flaubert, J., et al. (2021). [Reference details]. https://doi.org/10.1002/pul2.12188
Ghio, S., et al. (2024). [Reference details].
Kubota, M., et al. (2023). [Reference details].
Ong, K. (2020). [Reference details].
Sonnweber, T., et al. (2023). [Reference details].
Talwar, R., et al. (2022). [Reference details].
Vraka, A., et al. (2023). [Reference details].
Bernardo, A., & Perez, M. (2023). [Reference details].
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