Does Left Atrial Appendage Closure via implanted device reduce ischemic stroke readmissions and mortality in older Medicare patients with atrial fibrillation who are ineligible for warfarin?
Medicare patients older than 65 years with atrial fibrillation who are ineligible to receive warfarin and have a high number of comorbidities
Left Atrial Appendage Closure (LAAC) via implanted device
Expected rates based on CHA2DS2-VASc scores in the absence of anticoagulation therapy (historical/expected comparator)
Readmission rates for ischemic strokes at 6 months and mortality at 1 yearhard clinical
In a real-world Medicare population of older, sicker patients with atrial fibrillation ineligible for warfarin, LAAC yielded lower-than-expected 6-month ischemic stroke readmissions but higher 1-year mortality compared to historical RCTs.
In this cohort study of patients older than 65 years with atrial fibrillation who underwent LAAC with an implanted device, readmission rates for ischemic strokes over the course of 6 months were lower than expected given the patients' CHA2DS2-VASc scores in the absence of anticoagulation therapy. Mortality at 1 year was higher than that reported in previous randomized clinical trials, likely because the patients in the present study were older, had a higher number of comorbidities, and were ineligible to receive warfarin.
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Rajesh Kabra
Saket Girotra
Mary Vaughan‐Sarrazin
JAMA Network Open
University of Iowa
University of Tennessee Health Science Center
Iowa City VA Health Care System
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Kabra et al. (Wed,) studied this question.
www.synapsesocial.com/papers/69d56dfa75589c71d767d25f — DOI: https://doi.org/10.1001/jamanetworkopen.2019.14268