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Capella University

NURS-FPX8004 Advanced Doctoral Writing for Nurses

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Literature Review

Pulmonary hypertension (PH) is a progressive and potentially fatal disease with the onset of high pressure in the pulmonary arteries, which is caused by right heart failure and high mortality. Pharmacologic therapies are on the rise, but medication nonadherence and a lack of follow-up continue to be a major issue in the readmission and ill outcomes of PH patients (Guo et al., 2025). The practice problem in the tertiary cardiovascular center is the inconsistent monitoring and the insufficient nurse participation in the process of patient education and adherence management. The overall framework guiding the review is the PICO framework, which states: For the nursing staff working with adult patients with pulmonary hypertension in a tertiary cardiovascular center (P), how the introduction of a nurse-led intensive management program (I), in comparison to the current practices (C), regarding medication adherence rates (O) in 12 weeks (T)? PubMed, CINAHL, and Cochrane Library were searched using the following keywords: pulmonary hypertension, nurse-led management, adherence, and multidisciplinary care. The review below provides a synthesis of the existing body of evidence on nurse-led interventions, multidisciplinary coordination, and patient education to enhance adherence and patient outcomes in PH care.

Thematic Synthesis of Literature

Theme 1: Effectiveness of Nurse-Led Intensive Management on Survival and Rehospitalization

The literature has shown that nurse-intensive management programs are beneficial towards patient survival rates, as well as reduction in rehospitalization rates in patients with pulmonary hypertension and cardiovascular complications, through the efforts of the nurses. Guo et al. (2023) have used a prospective observational study and found that patients integrated into an intensive care program under the leadership of a nurse had a 62 percent higher survival rate than patients in a traditional care program. The program presupposed regular monitoring and review, taking medications to check their condition, and monitoring the symptoms to prevent worsening at the initial stage. Likewise, Guo et al. (2024) discovered that follow-ups by nurses at three-month intervals facilitated functional class stability and resulted in reduced visits to the emergency department.

The authors attributed the improvement to the timely titration of medication and frequent monitoring of patients. In a longer study, Guo et al. (2025) found a long-term survival advantage in the high-risk patients with pulmonary hypertension as a result of the involvement in a nurse-led model by the patients. The researchers indicated that the creators of the study indicated the early signs of decompensation and organized education as the most prominent mediators of survival improvement. Iyngkaran et al., on the other hand, reviewed numerous nurse-led chronic disease management programs and provided mixed outcomes on the mortality outcomes in heart failure, which indicates disease-specific effects. The variation of program intensity and follow-up rate was affected by the ambivalent results. The results of different studies contributed to the fact that active involvement of nurses, frequent monitoring, and combining personal care contribute to the reduction of readmissions in the hospital and the overall prognosis in the framework of treating pulmonary hypertension (Guo et al., 2023; Guo et al., 2024; Guo et al., 2025; Iyngkaran et al., 2025). The comparison showed that the NI model of nurse management is more effective in creating greater survival benefits as compared to the low-intensity model or the distance model.

Theme 2: Nurse-Led Interventions and Medication Adherence through Patient Education and Follow-Up

It has been proven that in educational and professional follow-ups of chronic cardiovascular conditions, medication adherence and self-management behaviors are better through nurse-led interventions. Guo et al. (2023) were able to determine that patients who had subscribed to an intervention based on the management of pulmonary hypertension by nurses reported much higher adherence rates to prescribed treatments as compared to those who were provided care within the more traditional system, where the physician had two other individuals to handle the patients. Promotion was linked to frequent education on medication mechanisms, drug side effects, and symptom reporting.

On the same note, Bulto et al. (2023) discovered that nurse-led hypertension programs demonstrated high systolic and diastolic blood pressure 5- and 2-mm Hg reductions, respectively, which suggested greater adherence to antihypertensive treatment programs. The study attributed the outcome to the habitual engagement between the nurse and the patient, which enhanced compliance with lifestyle and medications. On the contrary, Qiu (2024) addressed various cardiovascular nursing interventions and observed that education alone did not allow for the same level of adherence because its follow-ups were regular. The review has emphasised the significance of compliance, which was more adhered to by regular interactions of nurses with certain instruction adjustments, based on patient feedback.

Likewise, Iyngkaran et al. (2025) discovered that there was a steady improvement of self-management in both nurse-led and multidisciplinary programs, but a small improvement in mortality with education delivered using short interventions, though not ongoing monitoring. The comparison evidence revealed that the educational strategy implementation must be effective regarding the frequency of follow-up and personalization. Guo et al. (2023) and Bulto et al. (2023) have shown that constant, systematic contact will lead to measurable improvement in adherence, and Qiu (2024) and Iyngkaran et al. (2025) have revealed the drawbacks of personal education. Among the overall findings, the combination of prolonged nurse-led follow-up and individualized education enables the increase of medication adherence in the long run and allows patients to become more independent in managing pulmonary hypertension.

Theme 3: Multidisciplinary Coordination and Hierarchical Care Models in Optimizing Patient Outcomes

Hierarchical nursing care models and multidisciplinary collaboration have become a vital part of efficient disease management in both cardiovascular and pulmonary populations. According to Guo et al. (2025), when a team comprised of nurses, cardiologists, pharmacists, and rehabilitation specialists was included in the treatment of pulmonary hypertension patients, all-cause mortality decreased by 62%. The researchers were able to determine that collaborative decision-making and timely communication were the main reasons for enhancing survival. Meanwhile, Zheng et al. (2023) tested a hierarchical model of care led by nurses in stroke-associated pneumonia prevention and discovered that the rate of infection decreased by 23.4% in comparison with regular care.

The intervention was based on the risk stratification and escalation plans of nurses, which is an arrangement of teamwork, just like the pulmonary hypertension management structure of Guo et al. (2025 ). By comparison, Zhao et al. (2025) studied the management of acute respiratory failure. They found that nurse-led bilevel positive airway pressure therapy demonstrated the same or better results compared to physician-led models and had much higher patient satisfaction and a lower rate of intubation. The paper has emphasized the ability of competent nurses to handle the complicated interventions without oversight in cooperative networks.

However, as Qiu (2024) discovered, inconsistency in multidisciplinary coordination resulted in inconsistencies in the outcomes, notwithstanding that fragmentation between care providers frequently reduced the sustainability of the intervention. The comparative outcome shows that regular interdisciplinary interaction has synergistic effects in various clinical settings. Guo et al. (2025), Zheng et al. (2023), and Zhao et al. (2025) proved that organized collaboration and hierarchical care combination can produce tangible (survival, complication prevention, patient satisfaction) outcomes. The lack of evidence convergence demonstrated that multidisciplinary, nurse-led models provide a long-term answer to the optimization of complex cardiovascular care outcomes.

Recommendations for Future Research and Practice

The research directions that the subsequent studies should follow include big randomized controlled studies to evaluate the long-term effects of nurse-intensive management schemes on medication adherence, survival, and outcomes of the pulmonary hypertension populations. In spite of the current evidence, which is largely strong, the evidence is mainly observational and single-centered (Guo et al., 2025; Guo et al., 2023). Comparative research on different follow-up rates, the adoption of telehealth, and other ways of availing information to the patients would provide the opportunity to identify the most economical and feasible intervention strategies (Iyngkaran et al., 2025).

Additionally, qualitative research on patient perceptions of the barriers to adherence and the practices involving nurses and patients would be capable of streamlining program constructions to become culturally and situation-specific (Qiu, 2024). The multidisciplinary collaboration and the introduction of the standardized nurse-led follow-up protocols are expected to become a part of the clinical practice to increase adherence and reduce readmission to the hospital. The continuation of the outcome monitoring due to the evidence-based measurement will lead to the adaptation of the program and the implementation of the changes based on the new instructions of the management of pulmonary hypertension.

Conclusion