(1517) Real-World Evaluation of Angiotensin II Use in the Treatment of Shock

Introduction: Angiotensin II (ATII) (Giapreza) is a vasoconstrictor used for the treatment of vasodilatory shock. ATII differs from the other vasoactive agents available for the treatment of shock, which work via the adrenergic or vasopressin system. The ATHOS-3 study showed that ATII effectively increased blood pressure in patients with vasodilatory shock refractory to high doses of vasopressors. The purpose of this evaluation was to describe the usage and outcomes of ATII in a non-controlled patient population.

Methods: A retrospective review of adult patients who had received angiotensin II for more > 3 hours from January 2020 to March 2023 were included. The primary endpoint was a response to ATII defined as a MAP increase by 10 mmHg or greater than or equal to 75 mmHg at 3 hours post-initiation of ATII. Secondary endpoints evaluated discontinuation/decrease or addition/increase in dose of any concomitant vasopressors at 3 hours of ATII initiation, appropriateness of initial dosing and adverse effects.

Results: 49 patients were included in this evaluation with median age of 69 years. 75% of patients received ATII for septic shock, 21%, and 4% received ATII for cardiogenic/vasoplegic or hypovolemic shock, respectively, and 61%, 29%, 8% and 2% were admitted to the MICU, CICU, community ICU and NICU, respectively. 92% of patients were in norepinephrine (NE) and 78% on vasopressin (Vaso) at the time of ATII initiation. Patients started on angiotensin II had a baseline median MAP score was 70.5 (IQR 62- 79), at 3 hours was 74 (IQR 65-81). 53% of the patients had reached a composite endpoint at 3 hours and 8% of patients develop digital ischemia post-ATII initiation. 24% of patients on NE had doses increased and 47% had doses decreased and 11% of patients had Vaso increased or added and 3% had doses decreased at 3 hours post-ATII initiation. 39% of patients were initiated on doses not recommended in the package labeling.

Conclusions: ATII did not increase MAP as effectively shown in the ATHOS-3 study results. Education is needed to assure patients with vasodilatory shock are initiated properly at an appropriate dose.