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Comparative Study
. 2021 Jul;44(7):1143-1150.
doi: 10.1111/pace.14255. Epub 2021 May 24.

Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management

Abdullah Haddad  1 , Matthew Bocchese  2 , Rebecca Garber  3 , Brian O'Neill  4 , George A Yesenosky  5 , Pravin Patil  1 , Martin G Keane  1 , Sabrina Islam  1 , Jacqueline M Sherrer  1 , Anuj Basil  5 , Chethan Gangireddy  5 , Joshua M Cooper  5 , Edmond M Cronin  5 , Isaac R Whitman  5
Affiliations
Comparative Study

Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management

Abdullah Haddad et al. Pacing Clin Electrophysiol. 2021 Jul.

Abstract

Purpose: Non-white patients are underrepresented in left atrial appendage occlusion (LAAO) trials, and racial disparities in LAAO periprocedural management are unknown.

Methods: We assessed sociodemographics and comorbidities of consecutive patients at our institution undergoing LAAO between 2015 and 2020, then in adjusted analyses, compared procedural wait time, procedural complications, and post-procedure oral anticoagulation (OAC) use in whites versus non-whites.

Results: Among 109 patients undergoing LAAO (45% white), whites had lower CHA2 DS2 VASc scores, on average, than non-whites (4.0 vs. 4.8, p = .006). There was no difference in median time from index event (IE) or initial outpatient cardiology encounter to LAAO procedure (whites 10.5 vs. non-whites 13.7 months, p = .9; 1.9 vs. 1.8 months, p = .6, respectively), and there was no difference in procedural complications (whites 4% vs. non-whites 5%, p = .33). After adjusting for CHA2 DS2 VASc score, OAC use at discharge tended to be higher in whites (OR 2.4, 95% CI [0.9-6.0], p = .07). When restricting the analysis to those with prior gastrointestinal (GI) bleed, adjusting for CHA2 DS2 VASc score and GI bleed severity, whites had a nearly five-fold odds of being discharged on OAC (OR 4.6, 95% CI [1-21.8], p = 0.05). The association between race and discharge OAC was not mediated through income category (total mediation effect 19% 95% CI [-.04-0.11], p = .38).

Conclusion: Despite an increased prevalence of comorbidities amongst non-whites, wait time for LAAO and procedural complications were similar in whites versus non-whites. Among those with prior GI bleed, whites were nearly five-fold more likely to be discharged on OAC than non-whites, independent of income.

Keywords: Watchman; atrial fibrillation; cerebrovascular accident; left atrial occlusion device; mediation analysis; racial disparities.

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References

REFERENCES

    1. Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104:1534-1539.
    1. Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Prevalence HRG. Age distribution, and gender of patients with atrial fibrillation: analysis and implications. Arch Internal Med. 1995;155:469-473.
    1. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adultsnational implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA. 2001;285:2370-2375.
    1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129:837-847.
    1. January CT, Wann LS, Calkins H, et al. AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the american college of cardiology/american heart association task force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons. Circulation. 2019;140:e125-e51.

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