191: IMPACT OF AN ANTI-IMPULSE PHARMACOTHERAPY ORDER SET IN AORTIC SYNDROMES: INTERIM DATA

Abstract

Introduction: Anti-impulse therapy is used to describe the strategy to rapidly manage heart rate and blood pressure control in patients presenting with acute aortic syndromes (AAS). Patients presenting with AAS that have delayed transition from intravenous (IV) to oral anti-impulse therapy may encounter increased medication costs and length of stay (LOS). The objective of this study is to determine how an anti-impulse pharmacotherapy order set impacts the transition from IV to oral therapy in medically managed AAS patients and the subsequent impact on length of stay (LOS). Methods: A single-center, retrospective chart review of adult patients admitted to the cardiovascular intensive care unit (CVICU) for medical management of AAS was conducted from December 2020 to May 2022. Prior to this study, an anti-impulse order set was implemented through the electronic health record on March 18, 2022. Data on duration of continuous IV anti-impulse medications were collected to compare patients treated pre- and post-order set implementation. Patient demographics, ICU LOS, hospital LOS, cost of anti-impulse therapy, and time to initiate enteral medications for heart rate and blood pressure control were also obtained. Results: There were 27 patients in the pre-implementation group and seven patients assessed to date in the post-implementation group. The cohort of patients included in this study had a median age of 68 (IQR 55-81), were primarily male (66.7%), and the majority were white (84.8%). Type B aortic dissections was the most common type of medically managed AAS (57.6%). Implementation of an order set resulted in a reduction of continuous IV beta-blocker median duration of therapy by 18.2 hours (49.9 hours pre-implementation vs 31.7 hours post-implementation). Median duration of IV vasodilator therapy was also reduced by 23.7 hours (48.3 hours pre-implementation vs. 24.6 hours post implementation). There was no difference in median ICU LOS, however, hospital LOS was decreased by 35 hours after order set implementation. Conclusions: Interim analysis of use of an anti-impulse order set appears to be associated with a decreased duration of continuous infusion IV beta-blockers and vasodilators resulting in quicker oral therapy stabilization and subsequent decreased hospital length of stay.