Key result
Among patients undergoing left atrial appendage occlusion, females experienced significantly higher rates of in-hospital cardiac complications than males (5.8% vs 3.75%; aOR 1.5, 95% CI 1.35-1.68).
Why the study?
Left atrial appendage occlusion with the WATCHMAN device is used for atrial fibrillation and flutter, but sex-based differences in outcomes remain to be clarified.
Does female sex increase the risk of in-hospital complications and adverse outcomes compared to male sex in patients undergoing left atrial appendage closure with the Watchman device?
Observational (n=38,105)
Yes
Does female sex increase the risk of in-hospital complications and adverse outcomes compared to male sex in patients undergoing left atrial appendage closure with the Watchman device?
Odds Ratio: 1.5 (95% CI 1.35–1.68)
Absolute Event Rate: 5.8% vs 3.75%
Female patients undergoing left atrial appendage occlusion with the Watchman device experience significantly higher rates of in-hospital complications, mortality, and prolonged length of stay compared to males.
Women face higher periprocedural risks after Watchman LAAO; leaves open whether sex-specific strategies warrant prospective evaluation.
AIMS: Left atrial appendage occlusion (LAAO) with WATCHMAN device is being used for patients with atrial fibrillation (AFB) and, as an off-label use, atrial flutter (AFL) who can't comply with long-term anticoagulation. We aim to study the differences in outcomes between sexes in patients undergoing Watchman device implantation. METHODOLOGY: The National Inpatient Sample was queried between 2016 and 2019 using ICD-10 clinical modification codes I48x for AFB and AFL. Patients who underwent LAAO were identified using the procedural code 02L73DK. Comorbidities and complications were identified using ICD procedure and diagnosis codes. Differences in primary outcomes were analyzed using multivariable regression and propensity score matching. RESULTS: 38 105 admissions were identified, of which 16 795 (44%) were females (76 ± 7.6 years) and 21 310 (56%) were males (75 ± 8 years). Females were more likely to have cardiac (frequencies: 5.8% vs 3.75%, aOR: 1.5 [1.35-1.68], p1 day inpatient (1.79 [1.67-1.93], P < 0.01) and be discharged to a facility (1.54 [1.33-1.80], P < 0.01). CONCLUSION: Females are more likely to develop cardiac, renal, bleeding, pulmonary and TEE-related complications following LAAO procedure, while concurrently showing higher mortality, length of stay and discharge to facilities.
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Alhuarrat et al. (2023) conducted an observational in Atrial fibrillation and atrial flutter (n=38,105). Female sex vs. Male sex was evaluated on Cardiac complications (aOR 1.5, 95% CI 1.35-1.68). Among patients undergoing left atrial appendage occlusion, females experienced significantly higher rates of in-hospital cardiac complications than males (5.8% vs 3.75%; aOR 1.5, 95% CI 1.35-1.68).
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