Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 9;12(14):4573.
doi: 10.3390/jcm12144573.

Safety and Healthcare Resource Utilization in Patients Undergoing Left Atrial Appendage Closure-A Nationwide Analysis

Tharusan Thevathasan  1   2   3   4 , Sêhnou Degbeon  1 , Julia Paul  1 , Darius-Konstantin Wendelburg  1 , Lisa Füreder  1 , Anna Leonie Gaul  1 , Jan F Scheitz  2   3   5 , Gertraud Stadler  6 , Andi Rroku  1   3 , Sonia Lech  7   8 , Pichit Buspavanich  6   9 , Martin Huemer  1 , Philipp Attanasio  1 , Patrick Nagel  1 , Markus Reinthaler  1   3 , Ulf Landmesser  1   2   3 , Carsten Skurk  1   3
Affiliations

Safety and Healthcare Resource Utilization in Patients Undergoing Left Atrial Appendage Closure-A Nationwide Analysis

Tharusan Thevathasan et al. J Clin Med. .

Abstract

Percutaneous left atrial appendage closure (LAAC) has emerged as a non-pharmacological alternative for stroke prevention in patients with atrial fibrillation (AF) not suitable for anticoagulation therapy. Real-world data on peri-procedural outcomes are limited. The aim of this study was to analyze outcomes of peri-procedural safety and healthcare resource utilization in 11,240 adult patients undergoing LAAC in the United States between 2016 and 2019. Primary outcomes (safety) were in-hospital ischemic stroke or systemic embolism (SE), pericardial effusion (PE), major bleeding, device embolization and mortality. Secondary outcomes (resource utilization) were adverse discharge disposition, hospital length of stay (LOS) and costs. Logistic and Poisson regression models were used to analyze outcomes by adjusting for 10 confounders. SE decreased by 97% between 2016 and 2019 [95% Confidence Interval (CI) 0-0.24] (p = 0.003), while a trend to lower numbers of other peri-procedural complications was determined. In-hospital mortality (0.14%) remained stable. Hospital LOS decreased by 17% (0.78-0.87, p < 0.001) and adverse discharge rate by 41% (95% CI 0.41-0.86, p = 0.005) between 2016 and 2019, while hospital costs did not significantly change (p = 0.2). Female patients had a higher risk of PE (OR 2.86 [95% CI 2.41-6.39]) and SE (OR 5.0 [95% CI 1.28-43.6]) while multi-morbid patients had higher risks of major bleeding (p < 0.001) and mortality (p = 0.031), longer hospital LOS (p < 0.001) and increased treatment costs (p = 0.073). Significant differences in all outcomes were observed between male and female patients across US regions. In conclusion, LAAC has become a safer and more efficient procedure. Significant sex differences existed across US regions. Careful considerations should be taken when performing LAAC in female and comorbid patients.

Keywords: atrial fibrillation; bleeding; epidemiology; left atrial appendage closure; sex difference; stroke.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient flow diagram. This figure displays the number of patients with atrial fibrillation who underwent percutaneous left atrial appendage closure in the starting and final cohort after exclusion of patients with missing values.
Figure 2
Figure 2
Peri-procedural outcomes stratified by year of left atrial appendage closure. Odds Ratios and Incidence Rate Ratio for primary (a) and secondary outcomes (b–d) are displayed for each year between 2016 and 2019.
Figure 3
Figure 3
Peri-procedural in-hospital event rates stratified by female and male patients undergoing left atrial appendage closure across US regions. This figure displays the event rates for peri-procedural outcomes (I–VI) in female (a) and male (b) patients. Shades of blue color indicate lower event rates, while shades of red color indicate higher event rates.
See this image and copyright information in PMC

References

    1. James S.L., Abate D., Abate K.H., Abay S.M., Abbafati C., Abbasi N., Abbastabar H., Abd-Allah F., Abdela J., Abdelalim A., et al. Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 354 Diseases and Injuries for 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–1858. doi: 10.1016/S0140-6736(18)32279-7. - DOI - PMC - PubMed
    1. Colilla S., Crow A., Petkun W., Singer D.E., Simon T., Liu X. Estimates of Current and Future Incidence and Prevalence of Atrial Fibrillation in the U.S. Adult Population. Am. J. Cardiol. 2013;112:1142–1147. doi: 10.1016/j.amjcard.2013.05.063. - DOI - PubMed
    1. January C.T., Wann L.S., Calkins H., Chen L.Y., Cigarroa J.E., Cleveland J.C., Ellinor P.T., Ezekowitz M.D., Field M.E., Furie K.L., et al. 2019 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–e151. doi: 10.1161/CIR.0000000000000665. - DOI - PubMed
    1. Hindricks G., Potpara T., Dagres N., Arbelo E., Bax J.J., Blomström-Lundqvist C., Boriani G., Castella M., Dan G.-A., Dilaveris P.E., et al. 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed with the Special Contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021;42:373–498. doi: 10.1093/EURHEARTJ/EHAA612. - DOI - PubMed
    1. Virani S.S., Alonso A., Aparicio H.J., Benjamin E.J., Bittencourt M.S., Callaway C.W., Carson A.P., Chamberlain A.M., Cheng S., Delling F.N., et al. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021;143:E254–E743. doi: 10.1161/CIR.0000000000000950. - DOI - PubMed

LinkOut - more resources