From the Guidelines
The treatment plan for this 52-year-old patient with multiple acute conditions, including NSTEMI, atrial fibrillation, AKI, UTI, and suicidal ideation, requires a comprehensive approach prioritizing morbidity, mortality, and quality of life. For cardiac management, continue losartan for blood pressure control and cardiac protection, metoprolol for rate control of atrial fibrillation, and aspirin for antiplatelet therapy following the NSTEMI, as recommended by guidelines such as those outlined in 1 and 1. Maintain Jardiance (empagliflozin) for its dual benefits of glycemic control and cardio-renal protection, which is particularly important given the patient's AKI. For the UTI, appropriate antibiotics should be initiated based on urine culture results. To address the patient's psychiatric needs, hydroxyzine has been started for anxiety and agitation management, and STAR Care crisis evaluation has been arranged with McKanda from the crisis line coordinating the psychiatric assessment. Close monitoring of cardiac markers, renal function parameters, mental status, and vital signs is essential to track improvement, following the principles of comprehensive management as suggested in 1. Regular communication between cardiology, nephrology, and the STAR Care psychiatric team will ensure comprehensive care coordination. The patient requires close follow-up to adjust medications as needed based on improvement in cardiac status, renal function, infection clearance, and psychiatric stability, aligning with the dynamic evaluation and reassessment recommended in 1. Key considerations include the management of atrial fibrillation according to the AF-CARE pathway, which includes comorbidity and risk factor management, avoidance of stroke and thromboembolism, reduction of symptoms, and evaluation and dynamic reassessment, as outlined in 1. Given the most recent and highest quality guidelines from 1, the focus should be on a patient-centered approach, with shared care, equal care, education, and a thorough initial evaluation, including assessment of comorbidities and risk factors, which are critical in managing AF and other conditions effectively. The choice of anticoagulant, dose, and management strategy should be based on the latest recommendations, prioritizing DOACs over VKAs when appropriate, and considering the patient's specific risk factors and conditions, as discussed in 1. Ultimately, the goal is to improve the patient's quality of life, reduce morbidity, and prevent mortality, through a multifaceted and coordinated care plan.
From the Research
Treatment Plan Overview
The patient is a 52-year-old with multiple comorbidities, including NSTEMI, atrial fibrillation, AKI, UTI, and suicidal ideation. The treatment plan aims to stabilize cardiac and psychiatric conditions while managing comorbidities.
Medication Management
- Losartan has been refilled for blood pressure and cardiac protection, which is supported by a study 2 that found losartan to be effective in preventing atrial fibrillation recurrence in hypertensive patients.
- Metoprolol is continued for rate control, and aspirin is used for antiplatelet effect. A study 3 discusses the importance of β-blockers in cardiovascular disease management and provides guidance on switching between different β-blockers.
- Jardiance is maintained for glycemic control with cardio-renal benefits.
- Hydroxyzine has been started for anxiety and agitation.
Psychiatric Management
- A STAR Care crisis evaluation has been arranged with McKanda from the crisis line to coordinate psychiatric assessment.
- The biopsychosocial model 4 can be used to guide patient-centered neurological treatments, considering biological, psychological, and social-cultural-spiritual factors.
Monitoring and Follow-up
- The patient will be monitored for improvement in cardiac status, renal function, mental health, and vital signs.
- Communication will be maintained with the STAR Care team for psychiatric follow-up and with cardiology and nephrology for ongoing medical management.
- Studies 5 and 6 highlight the importance of patient-centered and interdisciplinary care approaches in managing complex conditions, which can inform the patient's treatment plan.