(169) Heart Rate and Pain Management in Type B Aortic Dissection Patients in the Emergency Department

Introduction: Type B aortic dissections, a relatively uncommon diagnosis encountered in the Emergency department (ED), are associated with high morbidity and mortality rate. Treatment for these patients includes strict systolic blood pressure (SBP) and heart rate (HR) control ( < 60 beats per minute [bpm]) per the American Heart Association (AHA) guidelines. Predictors for successful HR management in ED have not been extensively studied.

Methods: We retrospectively analyze the records of adult patients between 2017–2020 that presented to any ED with Type B aortic dissections with SBP > 120mmHg and HR > 60bpm, who were subsequently directly transferred and admitted to the critical care resuscitation unit (CCRU) at a quaternary academic center. We performed multivariable ordinal and univariate probit logit regressions for potential successful factors associated with HR control, defined as HR < 60 mmHg at leaving ED.

Results: One-hundred-forty-three patients fulfilled our inclusion criteria and were included in our data analysis. Mean (+/-SD) triage HR and pain scores were 78 (18) bpm and 6 (4), respectively. Mean (SD) HR and pain scores at the time of transfer were 76 (16) bpm and 5 (4), respectively. Delta HR, defined as the difference between HR at time of transfer and HR at triage, was -2 (16). Ninety-six patients (67%) received antihypertensives while in the ED, however, only 40 patients (28%) received antihypertensive infusions. Multivariable ordinal logistic regression showed that patients with higher triage HR was significantly associated with HR > 81 at the time of transfer (coefficient = -0.10, OR = 0.90, 95% CI 0.88 – 0.93, p< 0.001). Probit logit regression showed if patients present with HR > 80 bpm, the probability of achieving HR < 60 bpm at time of transfer was 3%.

Conclusions: Most patients with Type B dissection did not have heart rates meeting AHA guidelines and only 67% of patients receiving AHT in the ED. More studies are needed to identify successful management of heart rate among patients with Type B dissections.