Change in hospitalization rates following transcatheter left atrial appendage occlusion
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Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, KS, USA
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
Department of Internal Medicine, Geisinger Medical Center, Danville, PA, USA
Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
Department of Cardiology, Westchester Medical Center, NY, USA
Department of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
Submission date: 2021-08-03
Acceptance date: 2021-08-30
Publication date: 2021-12-10
Arch Med Sci Atheroscler Dis 2021;6(1):191–195
Left atrial appendage occlusion (LAAO) is recommended in patients with non-valvular atrial fibrillation (AF) who have contraindications to or are intolerant of long-term oral anticoagulants (OAC), but its impact on hospitalization rates has not been well described. The objective of our study is to describe the incidence of all-cause, bleeding-related, and thrombosis-related hospitalizations before and after LAAO.

Material and methods:
We used the Nationwide Readmission Database to include patients aged ≥ 18 years with a diagnosis of AF who underwent transcatheter LAAO during the months of February-November in each year between 2016 and 2018. Patients who died during the index procedure or had missing length of hospital stay or mortality information were excluded.

A total of 27,633 patients were included (median age: 77 years, 41% female) with an average pre- and post-LAAO monitoring period of 6.5 and 5.5 months respectively. Of these, 10,808 (39.1%) patients had one or more admissions prior to the procedure compared to 7,196 (26.0%) after the procedure. There was a 26% reduction in incidence of all-cause admissions (rate ratio (RR) = 0.74, 95% confidence interval (CI): 0.71–0.76; p < 0.001), 49% reduction in bleeding-related admissions (RR = 0.51, 95% CI: 0.48–0.55; p < 0.001), and 71% reduction in thrombosis-related readmissions (RR = 0.29, 95% CI: 0.26–0.33; p < 0.001) after LAAO.

In a contemporary, nationally representative dataset, we found that LAAO is associated with a significant decrease in all-cause, bleeding-related, and thrombosis-related admissions. These findings lend support to the current use of transcatheter LAAO in clinical practice for patients with contraindications to OAC and/or at high risk of bleeding.