Key result
Left atrial appendage occlusion was associated with a lower 30-day readmission rate compared to non-LAAO atrial fibrillation patients (9.4% vs. 10.98%, p=0.002).
Why the study?
Real-world experience with postprocedural readmission rates and predictors of readmission in patients undergoing left atrial appendage occlusion is limited.
Does percutaneous left atrial appendage occlusion (LAAO) reduce all-cause 30-day readmission compared to non-LAAO management in patients with atrial fibrillation?
Observational (n=14,024)
Yes
Does percutaneous left atrial appendage occlusion (LAAO) reduce all-cause 30-day readmission compared to non-LAAO management in patients with atrial fibrillation?
Absolute Event Rate: 9.4% vs 10.98%
p-value: p=.002
LAAO procedures are associated with a lower 30-day readmission rate and in-hospital mortality compared to non-LAAO AF patients, though readmissions remain substantial and are frequently driven by gastrointestinal bleeding.
LAAO was associated with modestly lower 30-day readmissions in AF; hypothesis-generating and requires randomized confirmation before practice change.
Background Left atrial appendage occlusion (LAAO) devices have become a favorable alternative option among nonvalvular atrial fibrillation (AF) patients with long‐term contraindication to anticoagulation. Real‐world experience with postprocedural readmission rates and predictors of readmission in LAAO patients is limited. Objective To assess all‐cause 30‐day readmission rate and predictors of readmission after LAAO procedure in the United States. Method This retrospective observational study included all AF patients undergoing percutaneous LAAO procedures in the United States from January 1, 2016, and December 31, 2017, in the National Readmission Database. The primary outcome measure was all‐cause 30‐day readmission. A propensity score‐matched analysis compared outcomes with a non‐LAAO AF cohort. Result Among 14 024 LAAO procedures (age: 76 ± 8 years; 60.5% males), 9.4% were readmitted within 30‐days and, 0.2% died during their index hospitalization. The most frequent primary diagnosis during readmission among LAAO was gastrointestinal bleeding (12%). The incidence of LAAO procedures increased by 102%. In the multivariate model, gender and CHA 2 DS 2 ‐VASc failed to predict readmission. Age 55–64 years had lower odds (adjusted odds ratios [aOR]: 0.41; 95% confidence interval [CI]: 0.18–0.94), while drug abuse (aOR: 4.1; 95% CI: 1.34–12.54), and deficiency anemia (aOR: 1.88; 95% CI: 1.12–3.18) had higher odds of readmission. In propensity‐matched cohort, compared to non‐LAAO AF, LAAO patients had lower 30‐day readmission (9.4% vs. 10.98%, p = .002) and all‐cause in‐hospital mortality (0.19% vs. 0.57%, p < .001). Conclusion The readmission rate following the LAAO procedure is substantial (approximately 10%), and largely attributable to gastrointestinal bleeding. Factors such as drug abuse and anemia must be explored further to minimize readmission risk.
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Pasupula et al. (2021) conducted an observational in Nonvalvular atrial fibrillation (n=14,024). Percutaneous left atrial appendage occlusion (LAAO) vs. Non-LAAO atrial fibrillation cohort was evaluated on All-cause 30-day readmission (p=.002). Left atrial appendage occlusion was associated with a lower 30-day readmission rate compared to non-LAAO atrial fibrillation patients (9.4% vs. 10.98%, p=0.002).
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