NURS FPX 8004 Assessment 3 Annotated Bibliography

NURS-FPX 8004 Assessment 3

Annotated Bibliography

Student Name

Capella University

NURS-FPX8004

Professor Name

Submission Date

Introduction

Southern United States Medical Center is an academic facility in a metropolitan area that focuses on cardiovascular and pulmonary medicine. Difficulties in the management of pulmonary vascular disease (PVD) have been noted, especially with critically ill patients in intensive care units (ICUs), where there is late diagnosis and varied treatment because there are no standardized protocols (Nurse Executive, personal communication, July 28, 2025).

PVD also raises the death rate and makes the hospital stay longer, particularly among middle-aged and elderly adults with underlying lung and heart issues. The group that is most vulnerable is ICU patients who need to be treated in a coordinated and timely way. The major stakeholders in the process of filling the care gap are ICU physicians, pulmonologists, nurses, quality improvement teams, and hospital administrators.

The introduction of a standardized screening procedure of PVD in ICUs is likely to raise the rate of timely diagnoses due to the introduction of uniformity in care and alignment of national practices. This evidence-based, structured method will enhance management of PVD, maximize the utilization of clinical resources, and overall patient care (Ejikeme & Safdar, 2024). The problem which was identified is articulated in the following PICOT statement: In critically ill ICU patients that are diagnosed with pulmonary vascular disease (PVD) (P), what is the effect of a standardized PVD screening protocol (I), compared to the current non-standardized screening practices (C), on the early PVD diagnosis rate (O) within six months (T)? The care gap should be addressed, which will directly contribute to the organization’s mission to enhance quality, safety, and outcomes in critical care settings.

Search Strategy

The vast University online library was used to find scholarly articles on the management of PVD in patients in the ICU. The most critical databases that were used to locate the articles were PubMed, Medline, and ProQuest. The search terms were: PVD delayed diagnosis, the standard screening protocols on PVD, delayed screening practices on PVD patients, and PVD management. Also, the search was refined using the Boolean operators, which were AND, OR, and NOT (Alharbi & Stevenson, 2020).

A preliminary search produced 20 articles. The inclusion criteria were used to choose eight relevant articles: peer-reviewed studies devoted to critically ill adult populations published within five years (Alharbi & Stevenson, 2020). Case studies and studies that were irrelevant to PVD standardized screening were not included in the exclusion criteria. The chosen research studies provided a reasonable basis for analyzing the effects of routine screening on patient outcomes, as all focused on PVD screening procedures, treatment modalities, and clinical outcomes in critical care units.

Annotated Bibliography

DuBrock, H. M., Germack, H. D., Gauthier-Loiselle, M., Linder, J., Satija, A., Manceur, A. M., Cloutier, M., Lefebvre, P., Panjabi, S., & Frantz, R. P. (2023). Economic burden of delayed diagnosis in patients with pulmonary arterial hypertension (PAH). PharmacoEconomics Open, 8(1), 133-146. https://doi.org/10.1007/s41669-023-00453-8

The authors studied the economic impact of late diagnosis of pulmonary arterial hypertension (PAH) in the United States. A retrospective study identified three cohorts of 538 adults with PAH (20162021) of a delay in the diagnosis of 0 to 12 months, >12 and = 24, and >24 months. It was concluded that longer critical care unit stays, 30-day readmissions, and increased medical costs were linked to further diagnostic delays.

Specifically, the monthly expenditure on patients was higher by $ 3,986 and $ 5,366 in cases where the delay was between 12 to 24 months and 24 months or more, respectively. Based on the findings, early detection of PAH is needed to curb the economic cost. The study’s results measure the economic implications of late PAH diagnosis and the financial value of initiating and sustaining continuous screening procedures. The study results were added to the literature because the authors determined the healthcare use and expenses of PAH diagnostic delays, which can be used to implement effective measures to reduce healthcare expenses.

Research/QI: Research Design

Ejikeme, C., & Safdar, Z. (2024). Exploring the pathogenesis of pulmonary vascular disease. Frontiers in Medicine, 11, e02639. https://doi.org/10.3389/fmed.2024.1402639

This study was aimed at investigating the pathogenesis of PVD with a particular emphasis on epigenetic mechanisms in pulmonary arterial hypertension. The authors utilized a narrative literature review research design, and they have synthesized findings of human and animal studies to derive the role of DNA methylation, histone modifications, and microRNAs in vascular remodeling.

This was the central theme of the study that involved the combination of preclinical and translational data to develop a mechanistic model of disease development. Findings showed that aberrant DNA methylation and histone acetylation interfere with inflammation, vasoconstriction, and smooth muscle proliferation-related gene expression. In contrast, perturbations in microRNA, including miR-204 and miR-17/92 cluster, modulate the signalling via pathways like BMPR2 and TGF-beta. These results support the key role of epigenetic regulation in endothelial dysfunction and right ventricular failure. The research adds to the literature by identifying epigenetic factors as potential biomarkers and drug targets that can be used in future personalised therapy approaches in pulmonary disorders such as hypertension.

Research/QI: Research Design

Erdogan, M., Avci, B. K., Ebren, C., Ersoy, Y., Ongen, Z., Ongen, G., Hamuryudan, V., & Hatemi, G. (2023). Screening for pulmonary arterial hypertension in patients with systemic sclerosis in the era of new pulmonary arterial hypertension definitions. Clinical and Experimental Rheumatology, 42(8), 1590-1597. https://doi.org/10.55563/clinexprheumatol/gzo4r2

The authors reviewed the results of three PAH screening tools, the European Society of Cardiology/European Respiratory Society (ESC/ERS), DETECT, and ASIG algorithms, in patients with systemic sclerosis (SSc), and compared them with the 2015 and 2022 ESC/ERS guidelines. The authors employed a prospective observational study in which 81 SSc patients who had never been diagnosed with PH were studied. The screening of patients was done using the three algorithms.

The results demonstrated that the ASIG algorithm had the most incredible sensitivity of 87.5% following the 2022 criteria, and no tool scored 100 percent sensitivity. The new 2022 guidelines make PAH detection 1.8 times more likely. Outcomes determined that existing algorithms might fail to identify all the diagnoses, thus the importance of a multi-modality approach. The value of the identified work lies in proposing changes to screening protocols, utilizing the existing diagnostic criteria for PAH to improve early diagnosis in SSc patients.

Research/QI: Research Design

Flores, A. M., Demsas, F., Leeper, N. J., & Ross, E. G. (2021). Leveraging machine learning and artificial intelligence to improve peripheral artery disease detection, treatment, and outcomes. Circulation Research, 128(12), 1833-1850. https://doi.org/10.1161/circresaha.121.318224

The research aimed to debate the contribution of artificial intelligence (AI) and machine learning (ML) to the enhancement of the detection, treatment, and outcomes of the disease, including peripheral artery disease (PAD), which is comparable to PVD in pathophysiology and systemic effects. The article reviewed and synthesized the data on the clinical trials, radiological investigations, and use of healthcare technology to explain how AI could help diagnose the disease, stratify the risk, optimize the treatment, and make intraoperative decisions.

The ML algorithms were revealed as significant for analyzing data from electronic health records, imaging, and wearable sensors to improve clinical decision-making and diagnostic accuracy. The authors concluded that AI can be employed to consolidate disjointed care across specialties and enhance interdisciplinary management of vascular conditions. The review contributes to the body of knowledge because the article offers a futuristic view regarding the means of integrating AI and ML into the practices of managing vascular diseases and the transferable lessons to pulmonary vascular disease.

Research/QI: Research Design

Hemnes, A. R., Celermajer, D. S., D’Alto, M., Haddad, F., Hassoun, P. M., Prins, K. W., Naeije, R., & Noordegraaf, A. V. (2024). Pathophysiology of the right ventricle and its pulmonary vascular interaction. European Respiratory Journal, 64(4), e2024. https://doi.org/10.1183/13993003.01321-2024

The aim of the review was to examine recent progress in the knowledge of right ventricular (RV) pathophysiology and interplay with pulmonary vascular disease. The findings of molecular, physiological, and imaging studies published after the authors synthesized the World Symposium on Pulmonary Hypertension in 2018. In addition, the authors addressed the pivotal role of RV adaptation in patient outcomes and the inflammation-fibrosis axis as the driver of RV failure. In pre-clinical studies, antagonism of interleukin-6 and NLRP3 decreased RV fibrosis and improved RV function in rodent models, and increased IL-6 levels in humans were associated with worse RV function and prognosis.

The findings concluded that metabolic interventions, including fatty acid oxidation restoration and carnitine supplementation, enhanced the RV performance in both animal and human studies. The increased RV wall fibrosis (measured by T1 signals) was associated with low ejection fraction and with higher pulmonary artery stiffness, as stated by cardiac MRI findings. Also, the article discussed sex disparities in RV adaptation, which revealed that estrogen receptor-α signaling promotes RV adaptation in women with PVD. The research is also an essential addition to the literature because it identifies the pathways that can be targeted to correct RV dysfunction in PVD, including Wnt signaling, metabolic dysregulation, and fibroblast activation, which provides a mechanistic basis for future therapeutic targets.

Research/QI: Research Design

Kim, M. S., Hwang, J., Yon, D. K., Lee, S., Jung, S. Y., Park, S., Johnson, C. O., Stark, B., Razo, C., Aboyans, V., Adebayo, O., Aly, H., Anderson, J. A., Aryan, Z., Bagherieh, S., Banach, M., Bearne, L., Benseñor, I. M., Bhaskar, S., & Bhat, V. (2023). Global burden of peripheral artery disease and risk factors, 1990–2019: A systematic analysis for the global burden of disease study 2019. The Lancet Global Health, 11(10), e1553–e1565. https://doi.org/10.1016/s2214-109x(23)00355-8

The systematic study was intended to measure the burden of PVD globally, the modifiable risk factors associated, and time and socioeconomic stratum trends between 1990 and 2019 year. Based on the Global Burden of Disease Study 2019, the analysis showed that in 2019, 113 million persons aged 40 years and above had PVD, representing a global prevalence of 1.52 percent. The frequency of PVD increased strongly with age, being 14.91 percent in individuals of 80-84 years, and it was greater in females than in males.

The full burden of disability-adjusted life years (DALYs) attributed to modifiable risk factors, including tobacco use, high blood pressure, and high fasting glucose, contributed to 69.4 percent (64.2-74.3) of overall PVD-related DALYs. The results were analyzed as a U-shape of DALY and mortality per socio-demographic index (SDI), where the highest burden of PVD is projected in both the low and high SDI countries. Although the prevalence of PVD was higher in high-income areas, the rates of DALY were out of proportion in low-income environments, highlighting the global inequality of access to vascular care and outcomes. The results are also of great value to the literature on PVD because they offer a broad range of estimates beyond prevalence to worldwide trends of disability and mortality, confirming the necessity of preventive measures and policies.

Research/QI: Research Design

Kubota, K., Miyanaga, S., Akao, M., Mitsuyoshi, K., Iwatani, N., Higo, K., & Ohishi, M. (2023). Association of delayed diagnosis of pulmonary arterial hypertension with its prognosis. Journal of Cardiology, 83(6), 365-370. https://doi.org/10.1016/j.jjcc.2023.08.004

The research aimed to identify the correlations between patient outcomes and the delay of PAH diagnosis. The retrospective observational study involved sixty-six untreated patients of PAH diagnosed at the Kagoshima University Hospital between January 2008 and December 2021. The patients were categorized into two groups: those with an early diagnosis, less than 3 months, and those with a late diagnosis, more than 3 months.

In addition, the authors demonstrated that the late diagnosis was associated with the elevated mortality rate and slowed right ventricular (RV) function. Moreover, the older patients were more prone to appear with advanced disease, and they were more time-consuming to diagnose. The results point to the early identification of PAH as one of the primary elements of prognosis and the restriction of the disease course. The study adds value to the body of knowledge by highlighting the importance of going through screening procedures at an early stage to get a timely diagnosis and improved clinical outcomes not only in the young and working age, but also in the elderly age bracket..

Research/QI: Research Design

Rahaghi, F., Kolaitis, N. A., Adegunsoye, A., de Andrade, J., Flaherty, K. R., Lancaster, L., Lee, J., Levine, D. J., Preston, I. R., Safdar, Z., Saggar, R., Sahay, S., Scholand, M. B., Shlobin, O. A., Zisman, D. A., & Nathan, S. D. (2022). Screening strategies for pulmonary hypertension in patients with interstitial lung disease. Chest, 162(1), 145-155. https://doi.org/10.1016/j.chest.2022.02.012

The purpose of the study was to create consensus-driven approaches to the screening of pulmonary hypertension in patients with interstitial lung disease (ILD), a group at risk of pulmonary vascular complications. The modified Delphi method was used; 16 multidisciplinary pulmonologists with experience in PH and ILD took part in three survey rounds to achieve consensus on effective screening indicators. The qualitative method of study was employed, beginning with open-ended questions and then rating the level of agreement against predetermined screening criteria. Findings defined critical clinical indicators of PH suspicion, which were respiratory symptoms, imaging findings, pulse oximetry, and increased levels of brain natriuretic peptide (BNP) or NT-proBNP, as well as unexplained decreases in pulmonary function or exercise capacity.

Echocardiography and BNP testing were considered to be effective non-invasive methods, and right heart catheterization was accepted as the gold standard of the diagnostic process. The results highlight the importance of early assessment of hypertension in ILD patients, especially as there is an increased number of therapeutic options regarding pulmonary vascular disease. The research adds to the existing body of literature by creating expert-based screening guidelines that could be used to diagnose and treat hypertension, one of the most severe manifestations of pulmonary vascular disease, earlier.

Research/QI: Research Design

Conclusion

PVD management is critical concerning mechanistic knowledge, early diagnosis, and specific screening. Authors have highlighted the prognostic significance of early detection. The high-risk population screening programmes, such as those that involve people with interstitial lung disease or systemic sclerosis, are essential to diagnose patients at risk of PVD. Moreover, advancements in imaging technologies and biomarker research are contributing to more accurate and timely identification of the disease. In addition, the authors disclosed the PVD epidemiological patterns, which indicated disparities and stressed the necessity of prevention and intervention measures urgently. All in all, the literature is in favor of integrated, proactive approaches to reducing PVD burden.