Temporal Trends and Demographic Disparities in Percutaneous Left Atrial Appendage Occlusion Utilization in the United States, 2016–2022

Background Left atrial appendage occlusion (LAAO) provides non-pharmacological stroke prevention for non-valvular atrial fibrillation patients with contraindications to long-term oral anticoagulation. National long-term data on age-adjusted utilization trends and demographic adoption disparities remain limited. Objectives To evaluate national temporal trends, hospital characteristics, clinical acuity shifts, and demographic adoption patterns of percutaneous LAAO procedures. Methods Using the National Inpatient Sample (NIS) from 2016 through 2022, percutaneous LAAO procedures were identified using ICD-10-PCS code 02L73DK. Weighted national estimates were used to evaluate patient demographics, hospital factors, clinical acuity, and overall in-hospital mortality. Age-adjusted rates per 100,000 population were calculated using direct standardization to the 2000 U.S. standard population. Results A total of 190,020 weighted LAAO procedures were identified increasing from 4,875 in 2016 to 60,445 in 2022. The mean patient age was 76.3 ± 7.6 years, and 58.5% were male. Most patients were White (90.4%), while Hispanic (4.3%), Black (3.9%), and Asian/Pacific Islander (1.3%) patients accounted for smaller proportions of procedures. Most procedures were performed at urban teaching hospitals (87.0%). Overall in-hospital mortality was 0.1% (n = 225, p = 0.582). Minor APR-DRG risk of mortality increased from 43.5% to 55.5%, while all others decreased ( p < 0.001). Age-adjusted LAAO rates rose from 34.19 to 379.87 per 100,000 population ( p -trend < 0.01). Significant differences in utilization across racial groups persisted throughout the study period. Conclusions Percutaneous LAAO utilization expanded rapidly with exceptionally low inpatient mortality. Persistent gaps in age-adjusted rates highlight key racial, sex, and geographic disparities in structural heart care. Condensed Abstract Using the 2016–2022 National Inpatient Sample, this study evaluated temporal trends and demographic adoption patterns of percutaneous left atrial appendage occlusion (LAAO). Among 190,020 weighted procedures, annual volume increased from 4,875 to 60,445. In-hospital mortality was exceptionally low (0.1%). Age-adjusted procedural rates rose from 34.19 to 379.87 per 100,000 population. However, significant disparities persisted, characterized by heavy centralization in urban teaching hospitals (87.0%) and disproportionately lower absolute age-adjusted utilization among female, Black, Hispanic, and Asian/Pacific Islander patients compared to male and White cohorts. Targeted initiatives are needed to ensure equitable access to structural heart interventions.