2026 Eastern States Conference

Authors: Castin Schulz, PharmD; Natalia Smith, PharmD; Sharon Wilson, PharmD, BCPS, BCCCP; Jennifer Frawley, PharmD, BCPS, BCCCP; Wallace Johnson, MD; Megan Wanzer, DNP; Stephanie Katzer, DNP, AGACNP-BC; Nicholas Ledlich, PA; Samuel Tisherman, MD, FACS, FCCM 
Learning Objective: At the conclusion of my presentation, audience members will be able to describe the impact of optimization of intravenous to oral antihypertensives regarding time to oral antihypertensive conversion, intensive care unit length of stay, intravenous anti-hypertensive costs, and 30-day readmission rates. 
Background/Objective: Type B Aortic Dissection can be managed surgically or with anti-impulse therapy. Delays in transitioning from IV to PO antihypertensives raise complication risk and length of stay.  This hospital created an algorithm to facilitate this transition. 
Methods: This was a single-center, prospective, cohort study to determine time to oral medication transition pre and post implementation of an IV to PO protocol conducted at the University of Maryland Medical Center (UMMC). All patients with type B aortic dissections were identified through review of UMMC’s electronic medical records (EPIC).  Pre-algorithm data (July 1st, 2020 - June 20th, 2022) had previously been collected in a prior study (HP-00102749). The post-algorithm group data was collected from July 1st, 2024, through April 1st, 2026. Data was collected and stored using Research Electronic Data Capture (REDCap).  Descriptive statistics were used to summarize the study population. Categorical variables were compared between both intervention groups using chi-square or Fisher’s exact tests, as appropriate based on expected cell counts. Continuous variables were analyzed using the t-test for normally distributed data or the Wilcoxon rank-sum test for non-normally distributed data.  
Results: A total of 102 patients were included in this study with 51 patients each in the pre-algorithm and post-algorithm groups.  The time from IV to PO anti-hypertensive conversion was significantly reduced in the post-algorithm group compared to the pre-algorithm group (1.5 days vs 3.8 days; p=0.0005).  There was a slight trend toward reduction in total hospital length of stay in the post-algorithm group but not significant (7 days vs 8 days; p=0.3).  Time to arterial line removal was significantly shorter in the post-algorithm group (2.4 vs 5 days; p<0.0001).  There were no significant differences in intensive care unit length of stay, 30-day mortality, or safety outcomes.   
Conclusion: Implementation of the type B aortic dissection algorithm at UMMC reduced transition time from IV to PO antihypertensives with equivocal efficacy and safety outcomes.  Time to arterial line removal was also reduced suggesting more efficient IV therapy use.  Further exploration into potential cost savings and hospital readmission comparison is warranted. 
Self-Assessment Question: 
Which of the following is an anticipated outcome of using a standardized algorithm to transition intravenous to oral anti-hypertensives in patients with Type B Aortic Dissections (TBAD)? 
A: increased 30-day mortality 
B: reduced time to oral antihypertensive conversion 
C: increased intensive care unit length of stay 
D: delayed blood pressure control