Posted: September 6th, 2023
The patient is a 45-year-old male with a history of hypertension
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.
Patient Case Study:
The patient is a 45-year-old male with a history of hypertension, dyslipidemia, and tobacco use. He presents to the clinic with complaints of chest pain and shortness of breath. An electrocardiogram reveals ST-segment elevation in leads II, III, and AVF, consistent with an inferior wall myocardial infarction. The patient is diagnosed with an acute coronary syndrome and admitted to the hospital.
Administer aspirin 325mg, clopidogrel 600mg, and unfractionated heparin for antithrombotic therapy.
Perform coronary angiography within 24 hours of admission to evaluate for revascularization.
Initiate high-intensity statin therapy with atorvastatin 80mg to reduce the risk of future cardiovascular events.
The recommended decisions are supported by several clinical practice guidelines. According to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients with STEMI, aspirin, clopidogrel, and unfractionated heparin are recommended as initial antithrombotic therapy (O’Gara et al., 2013). Additionally, the guidelines recommend that patients with STEMI undergo coronary angiography and revascularization within 24 hours of admission (O’Gara et al., 2013). Furthermore, high-intensity statin therapy is recommended for secondary prevention in patients with acute coronary syndrome, including STEMI (Amsterdam et al., 2014).
The decisions recommended for this patient were aimed at reducing his risk of adverse cardiovascular events, including death, myocardial infarction, and stroke. Evidence suggests that the use of aspirin, clopidogrel, and heparin for antithrombotic therapy reduces mortality and major adverse cardiovascular events in patients with STEMI (Knuuti et al., 2021). Early coronary angiography and revascularization have also been shown to improve outcomes in patients with STEMI (O’Gara et al., 2013). Additionally, high-intensity statin therapy has been demonstrated to reduce the risk of recurrent cardiovascular events in patients with acute coronary syndrome (Amsterdam et al., 2014).
The decision to administer antithrombotic therapy and perform coronary angiography were likely to have immediate benefits in reducing the patient’s risk of adverse cardiovascular events. However, the impact of high-intensity statin therapy may not be immediately evident, as it takes time for cholesterol levels to decrease and for the benefits of statin therapy to become apparent. Nonetheless, evidence suggests that high-intensity statin therapy is effective in reducing the risk of recurrent cardiovascular events in patients with acute coronary syndrome (Amsterdam et al., 2014).
Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E., Ganiats, T. G., Holmes, D. R., Jaffe, A. S., Jneid, H., Kelly, R. F., Kontos, M. C., Levine, G. N., Liebson, P. R., Mukherjee, D., Peterson, E. D., Sabatine, M. S., Smalling, R. W., Zieman, S. J., & Members, A. T. F. (2014). 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 130(25), 2354-