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. 2023 Sep 17;5(12):950-964.
doi: 10.1016/j.cjco.2023.09.009. eCollection 2023 Dec.

Readmissions After Left Atrial Appendage Closure in Patients With Previous Ischemic Stroke or Transient Ischemic Attack

Robert T Sparrow  1 , Luciano A Sposato  1   2 , Mohamad A Alkhouli  3 , Santiago García  4 , Islam Y Elgendy  5 , Adrian A Kuchtaruk  1 , Hani Jneid  6 , M Chadi Alraies  7 , Nikolaos Tzemos  1 , Mamas A Mamas  8 , Rodrigo Bagur  1   8   9
Affiliations

Readmissions After Left Atrial Appendage Closure in Patients With Previous Ischemic Stroke or Transient Ischemic Attack

Robert T Sparrow et al. CJC Open. .

Abstract
in English, French

Background: We examined the frequency and risk factors associated with readmission after left atrial appendage closure (LAAC) in patients with and without previous ischemic stroke and/or transient ischemic attack (TIA).

Methods: Hospitalizations for LAAC were identified from the US National Readmission Database, 2016-2018. The primary outcome was the first unplanned readmission after LAAC, with readmission times stratified into those occurring within 0 to 30 days vs within 31 to 180 days. Patients were stratified based on the history of previous stroke and/or TIA.

Results: Of 12,901 discharges after LAAC, 28% had previous stroke and/or TIA, and 8.2% had a readmission within 30 days while 18% had a readmission within 31 to 180 days. The rates of in-hospital complications and readmissions at both periods were not significantly different between individuals with vs without previous stroke and/or TIA. Cardiac causes accounted for 28% of readmissions within 30 days and 32% of those within 31 to 180 days, and congestive failure, bleeding, and infections were the most common readmission diagnoses. New stroke and/or TIA accounted for 4% and 6% of the total noncardiac readmissions within 30 days and 31 to 180 days, respectively, and the incidence was higher among those with previous stroke and/or TIA. Female sex and index hospitalization length of stay (LOS) > 1 day were factors independently associated with readmission within 30 days, whereas LOS, diabetes, renal disease, chronic obstructive pulmonary disease, and anemia were among the factors associated with readmissions within 31 to 180 days.

Conclusions: Unplanned rehospitalizations were common after LAAC and had similar frequency for patients with vs without previous ischemic stroke and/or TIA. Female sex and index hospitalization LOS > 1 day were among the strongest factors that were independently associated with readmission within 30 days.

Contexte: Nous avons examiné la fréquence et les facteurs de risque des réadmissions consécutives à une fermeture de l'appendice auriculaire gauche (FAOG) chez les patients ayant ou non subi un accident vasculaire cérébral (AVC) ischémique et/ou un accident ischémique transitoire (AIT).

Méthodologie: Les hospitalisations pour une FAOG ont été recensées au moyen de la US National Readmission Database (base de données nationale des réadmissions aux États-Unis) pour la période 2016-2018. Le critère d’évaluation principal était la première réadmission non prévue après une FAOG, avec stratification du moment de la réadmission selon que celle-ci était survenue de 0 à 30 jours ou de 31 à 180 jours après l’intervention. Les patients ont été stratifiés en fonction des antécédents d’AVC et/ou d’AIT.

Résultats: Parmi les 12 901 patients ayant reçu leur congé de l’hôpital après une FAOG, 28 % avaient des antécédents d’AVC et/ou d’AIT; 8,2 % des patients admissibles ont été réadmis dans les 30 jours et 18 %, entre le 31e et le 180e jour suivant l’intervention. Aucune différence significative n’a été observée entre les patients ayant subi un AVC et/ou un AIT et les patients qui n’en avaient pas subi en ce qui concerne les taux de complications hospitalières et de réadmission durant ces deux périodes. Les causes cardiaques représentaient 28 % des réadmissions dans les 30 jours et 32 % des réadmissions entre le 31e et le 180e jour. L’insuffisance cardiaque congestive, les hémorragies et les infections ont été les causes les plus fréquentes de réadmission. Les nouveaux cas d’AVC et/ou d’AIT ont respectivement été à l’origine de 4 % et de 6 % de l’ensemble des réadmissions de cause non cardiaque dans les 30 jours, et entre le 31e et le 180e jour, et leur fréquence a été plus élevée chez les patients ayant des antécédents d’AVC et/ou d’AIT. Le sexe féminin et une durée d’hospitalisation initiale > 1 jour ont été des facteurs indépendants associés aux réadmissions dans les 30 jours, tandis que la durée de l’hospitalisation, un diabète, une néphropathie, une maladie pulmonaire obstructive chronique et une anémie faisaient partie des facteurs associés aux réadmissions entre le 31e et le 180e jour.

Conclusions: Les réhospitalisations non prévues ont été courantes après une FAOG, et leur fréquence a été similaire en présence ou en l’absence d’antécédents d’AVC ischémique et/ou d’AIT. Le sexe féminin et une durée d’hospitalisation initiale > 1 jour ont été les facteurs les plus importants associés aux réadmissions dans les 30 jours.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Graphical representation of time to cardiac and noncardiac readmissions after left atrial appendage closure. (A) Bar chart of 30-day cardiac and noncardiac readmission in the overall study population. (B) Histogram of 0-180–day cardiac and noncardiac readmissions stratified into 2-day intervals in the overall study population. (C) Histogram of 0-180–day cardiac and noncardiac readmissions among patients with previous stroke and/or transient ischemic attack stratified into 2-day intervals. (D) Histogram of 0-180–day cardiac and noncardiac readmissions among patients without previous stroke and/or transient ischemic attack, stratified into 2-day intervals.
Figure 2
Figure 2
Causes of 30-day and 31-180–day cardiac (top) and noncardiac (bottom) readmission after left atrial appendage closure. Percentages represent the proportion of readmissions attributable to each cause. For cardiac readmissions, “other” causes were most commonly coded for valvular heart disease and postprocedural cardiac complications. For noncardiac readmissions, “other” causes were mostly related to malignancy, diabetes mellitus, syncope, delirium, and nonspecific neurologic abnormalities. CHF, congestive heart failure; MI, myocardial infarction; TIA, transient ischemic attack.
Figure 3
Figure 3
Heatmap of odds ratios of multivariable models predicting readmission. Graphical representation of the odds ratios of each clinical factor for the models, with darker colours representing higher odds, irrespective of their P-value. (A) Odds ratios of 30-day readmission models. (B) Odds ratios of 31-180–day readmission models. Income-quartile 4 (75th-100th percentile) was used as the reference group for analysis. Cells with NA (not applicable) indicate that the comorbidity was not included in the model. CABG, coronary artery bypass grafting; COPD, chronic obstructive pulmonary disease; PCI, percutaneous coronary intervention; TIA, transient ischemic attack.
Figure 4
Figure 4
Readmission after left atrial appendage closure in patients with previous ischemic stroke or transient ischemic attack (TIA).
See this image and copyright information in PMC

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