Key result
An outpatient same-day discharge protocol for left atrial appendage occlusion resulted in similar 30-day composite adverse events compared to a conventional protocol (3.0% vs 6.1%; p=0.24).
Why the study?
Same-day discharge protocols have been proposed in structural heart disease, but this approach had not been studied in detail for percutaneous left atrial appendage occlusion.
Does an outpatient protocol for LAAO reduce hospital length of stay without increasing 30-day complications compared to a conventional protocol in patients with nonvalvular atrial fibrillation?
Cohort (n=262)
No
Does an outpatient protocol for LAAO reduce hospital length of stay without increasing 30-day complications compared to a conventional protocol in patients with nonvalvular atrial fibrillation?
Absolute Event Rate: 3% vs 6.1%
p-value: p=0.24
A same-day discharge protocol for LAAO is safe and feasible, significantly reducing hospital length of stay without increasing 30-day adverse events compared to conventional care.
Same-day LAAO discharge may reduce length of stay without raising 30-day risk; leaves open confirmation by randomized trials.
Background: Left atrial appendage occlusion (LAAO) is a safe and effective alternative to oral anticoagulation for thromboprophylaxis in patients with nonvalvular atrial fibrillation. Technological development in devices and imaging techniques, as well as accumulated experience, have increased procedural success rates and decreased complications. Same-day discharge protocols have been proposed in the field of structural heart disease, but this approach has not been studied in detail for the LAAO procedure. Aim: The aim of this study is to assess the safety and efficacy of an outpatient program for LAAO when compared to the conventional treatment approach. Methods: We present a retrospective, non-randomized single-center study of 262 consecutive patients undergoing LAAO. Patients were divided into two groups, the first (n = 131) followed a conventional protocol (CP), and the second (n = 131) an outpatient protocol (OP). The primary composite endpoint comprised MACCE (death, stroke, and bleeding), cardiac tamponade, vascular complication, or attendance in the emergency department after hospital discharge at 30 days. Results: The overall success rate was 99.6%, with a periprocedural complication rate of 2.29%. With regards to the CP versus OP group, there were no differences between incidences of the primary composite endpoint (6.1% PC vs. 3.0% PA, p = 0.24), or after an analysis, with propensity score matching. No differences were observed in the individual endpoints. There was a decrease in hospital length of stay in the same-day discharge group (p < 0.01). Conclusions: A same-day discharge LAAO program is safe, effective, and feasible when compared to the conventional strategy. Moreover, it reduces hospital length of stay, which might have clinical and economic benefits.
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Blanco-Fernández et al. (2023) conducted a cohort in Nonvalvular atrial fibrillation (n=262). Outpatient protocol (same-day discharge) vs. Conventional protocol was evaluated on MACCE (death, stroke, and bleeding), cardiac tamponade, vascular complication, or attendance in the emergency department after hospital discharge at 30 days (p=0.24). An outpatient same-day discharge protocol for left atrial appendage occlusion resulted in similar 30-day composite adverse events compared to a conventional protocol (3.0% vs 6.1%; p=0.24).
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