TY - JOUR
T1 - Outcomes and Readmissions after Left Atrial Appendage Occlusion in Octogenarians
T2 - A Contemporary Analysis
AU - Barsoum, Kirolos
AU - Khalil, Mahmoud
AU - Eid, Mohamed Magdi
AU - Hassib, Mohab
AU - Ibrahim, Fadi
AU - Khalife, Wissam
AU - Chatila, Khalid
AU - Pandey, Ritambhara
AU - Abdou, Claudine
AU - Bandyopadhyay, Dhrubajyoti
AU - Rai, Devesh
AU - Aronow, Wilbert S.
AU - Rangasetty, Umamahesh C.
N1 - Publisher Copyright:
© 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2024/2
Y1 - 2024/2
N2 - Introduction and Objectives: The outcomes of left atrial appendage occlusion (LAAO) with the Watchman device in octogenarians are unknown as this population was underrepresented in major clinical trials. This study aims at examining the causes and outcomes of readmission after LAAO. Design: A retrospective cohort study based on the National Readmission Database in the United States. Settings and Participant: Patients aged ≥80 years, admitted between January 2016 and December 2018, with the primary diagnosis of atrial fibrillation or flutter or who had LAAO were included in the study. Patients who died during index admission were excluded. Methods: We used the National Readmission Database and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify study participants. Data analysis was performed through Stata, version 17. Univariate and multivariate aggression analysis was used to adjust for confounders using Student t tests and χ2 tests. Results: We identified 491,329 patients on anticoagulation (AC) and 2030 patients who underwent LAA closure. Neither group differed regarding hypertension, previous myocardial infarction, or valvular heart disease. All-cause readmissions were lower in the LAAO group at 45 days (adjusted P <.01). All-cause readmissions at 45 and 90 days were similar in both groups. There was an increase in gastrointestinal bleeding (GIB) readmissions in the LAAO at 45 (P <.01), 90 (P <.01), and 180 (P <.01) days. There was no difference in GIB readmission between the 2 groups. There was no also difference in stroke or intracranial hemorrhage rates between the 2 groups throughout the follow-up period. Conclusion and Implications: In octogenarians who received LAAO, the rate of GIB increased during the first 6 months after the procedure; however, it was not different from that of AC after that. Special attention should be given to the antithrombotic regimens after LAAO to avoid bleeding in this vulnerable patient population.
AB - Introduction and Objectives: The outcomes of left atrial appendage occlusion (LAAO) with the Watchman device in octogenarians are unknown as this population was underrepresented in major clinical trials. This study aims at examining the causes and outcomes of readmission after LAAO. Design: A retrospective cohort study based on the National Readmission Database in the United States. Settings and Participant: Patients aged ≥80 years, admitted between January 2016 and December 2018, with the primary diagnosis of atrial fibrillation or flutter or who had LAAO were included in the study. Patients who died during index admission were excluded. Methods: We used the National Readmission Database and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes to identify study participants. Data analysis was performed through Stata, version 17. Univariate and multivariate aggression analysis was used to adjust for confounders using Student t tests and χ2 tests. Results: We identified 491,329 patients on anticoagulation (AC) and 2030 patients who underwent LAA closure. Neither group differed regarding hypertension, previous myocardial infarction, or valvular heart disease. All-cause readmissions were lower in the LAAO group at 45 days (adjusted P <.01). All-cause readmissions at 45 and 90 days were similar in both groups. There was an increase in gastrointestinal bleeding (GIB) readmissions in the LAAO at 45 (P <.01), 90 (P <.01), and 180 (P <.01) days. There was no difference in GIB readmission between the 2 groups. There was no also difference in stroke or intracranial hemorrhage rates between the 2 groups throughout the follow-up period. Conclusion and Implications: In octogenarians who received LAAO, the rate of GIB increased during the first 6 months after the procedure; however, it was not different from that of AC after that. Special attention should be given to the antithrombotic regimens after LAAO to avoid bleeding in this vulnerable patient population.
KW - Left atrial appendage closure
KW - Octagenerians
KW - atrial fibrillation
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UR - http://www.scopus.com/inward/citedby.url?scp=85171388618&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2023.06.016
DO - 10.1016/j.jamda.2023.06.016
M3 - Article
C2 - 37634550
AN - SCOPUS:85171388618
SN - 1525-8610
VL - 25
SP - 356.e1-356.e6
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 2
ER -