Key result
Rural hospital location shows no difference in inpatient complications or mortality vs urban centers after LAAO.
Why the study?
Disparities exist in managing AF across U.S. rural and urban hospitals, but studies examining outcomes and complications after LAAO by hospital location are lacking.
Does percutaneous left atrial appendage occlusion (LAAO) performed in rural hospitals compared to urban hospitals affect inpatient mortality, procedural complications, and resource utilization in patients with atrial fibrillation?
Cohort (n=89,300)
Yes
Does percutaneous left atrial appendage occlusion (LAAO) performed in rural hospitals compared to urban hospitals affect inpatient mortality, procedural complications, and resource utilization in patients with atrial fibrillation?
Although only 2.2% of US left atrial appendage occlusion procedures occurred in rural hospitals, adjusted inpatient mortality and major complication rates were comparable to urban hospitals, with rural hospitals demonstrating lower hospitalization costs and length of stay but slightly higher non-home discharge rates.
Answers are grounded in this paper and cite their sources.
Comparable inpatient outcomes support rural LAAO feasibility; leaves open long-term efficacy and access equity questions.
BACKGROUND: Disparities in management of atrial fibrillation in rural and urban hospitals across the U.S. have been reported. However, studies investigating disparities regarding outcomes and complications after left atrial appendage occlusion (LAAO) based on hospital location are lacking. OBJECTIVE: To evaluate differences in outcomes and complications related to LAAO among rural and urban hospitals. METHODS: The National Inpatient Sample was used to identify patients who underwent LAAO implantations in the U.S. from 2016-2020. Study endpoints assessed included inpatient complications, outcomes, and resource utilization after LAAO procedures among rural and urban hospitals. RESULTS: From 2016-2020, there were a total of 87 315 and 1985 LAAO device placements in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with a few exceptions. After multivariable adjustment for confounders, odds of inpatient complications and mortality were similar among both groups. However, rural LAAO recipients experienced greater rates of discharge to an acute care facility (3.3% vs 2.4%, p = 0.01), as well as lower costs (aOR: 0.58, 95% CI: 0.49-0.69) and length of stay (aOR: 0.89, 95% CI: 0.81-0.98). CONCLUSIONS: A majority of LAAO implantations occurred in urban hospitals in the U.S. Baseline characteristics and adjusted odds of inpatient complications and mortality were similar in rural and urban recipients. However, important differences were described regarding resource utilization and disposition. Further investigation into the specific factors driving these inequities is encouraged to promote improved access to and outcomes of cardiovascular care for rural residents.
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Nguyen et al. (2026) conducted a cohort in Atrial fibrillation undergoing percutaneous left atrial appendage occlusion (LAAO) (n=89,300). Rural hospital location for LAAO implantation vs. Urban hospital location for LAAO implantation was evaluated on Overall inpatient procedural complications (aOR 0.85, 95% CI 0.72-1.00). Rural hospital location had similar adjusted odds of overall inpatient complications (aOR 0.85, 95% CI 0.72-1.00) and mortality (aOR 1.16) compared to urban hospitals after LAAO.
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