September 24, 2021Journal of the American Heart AssociationOpen Access

Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure

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Why the study?

Elderly patients carry a higher burden of comorbidities that may influence outcomes, prompting comparison of in-hospital outcomes and risk factors for major adverse events after left atrial appendage closure between patients aged ≥80 years and younger patients.

Does age ≥80 years increase the risk of in-hospital major adverse events in patients undergoing left atrial appendage closure compared to younger patients?

Structured PICO

Does age ≥80 years increase the risk of in-hospital major adverse events in patients undergoing left atrial appendage closure compared to younger patients?

Population

6,779 patients undergoing left atrial appendage closure identified from the National Inpatient Sample between October 2015 and December 2018, including 2,371 (35%) aged ≥80 years and 4,408 (65%) aged <80 years.

Intervention

Left atrial appendage closure in patients ≥80 years old

Comparator

Left atrial appendage closure in patients <80 years old

Outcome

In-hospital major adverse events (MAE) defined as the composite of postprocedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and deathcomposite

Elderly patients (≥80 years) undergoing left atrial appendage closure have a significantly higher risk of in-hospital major adverse events compared to younger patients, with female sex and specific comorbidities further increasing this risk.

Implication

Age ≥80 was associated with higher in-hospital MAE after LAA closure; leaves open whether age should guide patient selection or trial design.

Abstract

Background Elderly patients have a higher burden of comorbidities that influence clinical outcomes. We aimed to compare in-hospital outcomes in patients ≥80 years old to younger patients, and to determine the factors associated with increased risk of major adverse events (MAE) after left atrial appendage closure. Methods and Results The National Inpatient Sample was used to identify discharges after left atrial appendage closure between October 2015 and December 2018. The primary outcome was in-hospital MAE defined as the composite of postprocedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and death. A total of 6779 hospitalizations were identified, of which, 2371 (35%) were ≥80 years old and 4408 (65%) were <80 years old. Patients ≥80 years old experienced a higher rate of MAE compared with those aged <80 years old (6.0% versus 4.6%, P=0.01), and this difference was driven by a numerically higher rate of cardiac complications (2.4% versus 1.8%, P=0.09) and death (0.3% versus 0.1%, P=0.05) among individuals ≥80 years old. In patients ≥80 years old, higher odds of in-hospital MAE were observed in women (1.61-fold), and those with preprocedural congestive heart failure (≈2-fold), diabetes (≈1.5-fold), renal disease (≈2.6-fold), anemia (≈2.7-fold), and dementia (≈5-fold). In patients <80 years old, a higher risk of in-hospital MAE was encountered among women (≈1.4-fold) and those with diabetes (≈1.3-fold), renal disease (≈2.6-fold), anemia (≈2-fold), and dyslipidemia (≈1.2-fold). Conclusions Patients ≥80 years old had higher rates of in-hospital MAE compared with patients aged <80 years old. Female sex and the presence of heart failure, diabetes, renal disease, and anemia were factors associated with in-hospital MAE among both groups.