Key result
Black patients undergoing left atrial appendage closure had a higher risk of in-hospital major adverse events compared with white patients (OR 1.60; 95% CI 1.22 to 2.10; p<0.001).
Why the study?
The impact of race, ethnicity, and socioeconomic status on in-hospital complication rates after left atrial appendage closure was unknown.
Does race/ethnicity or socioeconomic status impact in-hospital complication rates in patients undergoing left atrial appendage closure?
Observational (n=6,478)
Yes
Does race/ethnicity or socioeconomic status impact in-hospital complication rates in patients undergoing left atrial appendage closure?
Black patients undergoing left atrial appendage closure experience higher rates of in-hospital complications compared to white patients, highlighting significant racial disparities in procedural outcomes.
Black and lower-SES patients face higher LAAC complications; leaves open whether disparities reflect access, case mix, or care quality.
OBJECTIVE: This manuscript aims to explore the impact of race/ethnicity and socioeconomic status on in-hospital complication rates after left atrial appendage closure (LAAC). METHODS: The US National Inpatient Sample was used to identify hospitalisations for LAAC between 1 October 2015 to 31 December 2018. These patients were stratified by race/ethnicity and quartiles of median neighbourhood income. The primary outcome was the occurrence of in-hospital major adverse events, defined as a composite of postprocedural bleeding, cardiac and vascular complications, acute kidney injury and ischaemic stroke. RESULTS: Of 6478 unweighted hospitalisations for LAAC, 58% were male and patients of black, Hispanic and 'other' race/ethnicity each comprised approximately 5% of the cohort. Adjusted by the older Americans population, the estimated number of LAAC procedures was 69.2/100 000 for white individuals, as compared with 29.5/100 000 for blacks, 47.2/100 000 for Hispanics and 40.7/100 000 for individuals of 'other' race/ethnicity. Black patients were ~5 years younger but had a higher comorbidity burden. The primary outcome occurred in 5% of patients and differed significantly between racial/ethnic groups (p<0.001) but not across neighbourhood income quartiles (p=0.88). After multilevel modelling, the overall rate of in-hospital major adverse events was higher in black patients as compared with whites (OR: 1.60, 95% CI 1.22 to 2.10, p<0.001); however, the incidence of acute kidney injury was higher in Hispanics (OR: 2.19, 95% CI 1.52 to 3.17, p<0.001). No significant differences were found in adjusted overall in-hospital complication rates between income quartiles. CONCLUSION: In this study assessing racial/ethnic disparities in patients undergoing LAAC, minorities are under-represented, specifically patients of black race/ethnicity. Compared with whites, black patients had higher comorbidity burden and higher rates of in-hospital complications. Lower socioeconomic status was not associated with complication rates.
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Sparrow et al. (2021) conducted an observational in Left atrial appendage closure (n=6,478). Black race/ethnicity vs. White race/ethnicity was evaluated on In-hospital major adverse events (composite of postprocedural bleeding, cardiac and vascular complications, acute kidney injury and ischaemic stroke) (OR 1.60, 95% CI 1.22 to 2.10, p=<0.001). Black patients undergoing left atrial appendage closure had a higher risk of in-hospital major adverse events compared with white patients (OR 1.60; 95% CI 1.22 to 2.10; p<0.001).
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