Percutaneous left atrial appendage occlusion in heart failure: a nationwide readmission database analysis

Abstract

Objectives: Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for reducing stroke risk in patients with atrial fibrillation (AF). However, patients with heart failure (HF) may have an enhanced risk of stroke and elevated risk for this procedure. To further investigate this population, the authors present a retrospective analysis on LAAO in patients with HF.

Methods: The authors performed a retrospective review of all hospitalizations for LAAO using the National Readmissions Database between September 2015 and November 2019. From these, patients with ICD-10 codes for HF were identified. Propensity matched (PSM) analysis was used to compare matched samples of patients with and without HF. Outcomes assessed included all-cause mortality, stroke, major bleeding, pericardial effusion, tamponade, and acute kidney injury (AKI).

Results: After PSM, HF was associated with higher odds of mortality (odds ratio [OR] 2.79 [1.68-4.60]), major bleeding (OR 1.26 [1.08-1.46]), and AKI (OR 2.11 [1.84-2.41]) at index admission. Mortality (OR 1.45 [1.12-1.89]), major bleeding (OR 1.53 [1.13-2.07]), and AKI (OR 2.24 [1.81-2.79]) were also significantly higher at 30-day readmission. There was no significant increase in pericardial effusion, tamponade, or stroke after PSM at index admission or 30-day readmission.

Conclusions: The findings suggest LAAO use in HF is not associated with an increased risk of pericardial effusion, tamponade, and stroke in the periprocedural period when compared with those without HF. Mortality, major bleeding, and AKI were found to be modestly higher in patients with HF. Further investigation is warranted to evaluate the long-term risk of stroke in patients with HF with LAAO.

Keywords: acute kidney injury; atrial fibrillation; heart failure; left atrial appendage occlusion; pericardial effusion; stroke.