CLINICAL RESEARCH
Change in hospitalization rates following transcatheter left atrial appendage occlusion
 
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1
Department of Cardiovascular Medicine, The University of Kansas Health System, Kansas City, KS, USA
2
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
3
Department of Internal Medicine, Geisinger Medical Center, Danville, PA, USA
4
Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
5
Department of Cardiology, Westchester Medical Center, NY, USA
6
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
 
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ABSTRACT
Introduction:
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.

Results:
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.

Conclusions:
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.

ISSN:2451-0629