Outcomes of elderly patients undergoing left atrial appendage closure

Shubrandu S. Sanjoy, Yun Hee Choi, Robert T. Sparrow, Hani Jneid, J. Dawn Abbott, Luis Nombela-Franco, Lorenzo Azzalini, David R. Holmes, M. Chadi Alraies, Islam Y. Elgendy, Adrian Baranchuk, Mamas A. Mamas, Rodrigo Bagur

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

BACKGROUND: Elderly patients have a higher burden of comorbidities that influence clinical outcomes. We aimed to compare in-hospital outcomes in patients ≥80 years old to younger patients, and to determine the factors associated with increased risk of major adverse events (MAE) after left atrial appendage closure. METHODS AND RESULTS: The National Inpatient Sample was used to identify discharges after left atrial appendage closure between October 2015 and December 2018. The primary outcome was in-hospital MAE defined as the composite of post-procedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and death. A total of 6779 hospitaliza-tions were identified, of which, 2371 (35%) were ≥80 years old and 4408 (65%) were <80 years old. Patients ≥80 years old experienced a higher rate of MAE compared with those aged <80 years old (6.0% versus 4.6%, P=0.01), and this difference was driven by a numerically higher rate of cardiac complications (2.4% versus 1.8%, P=0.09) and death (0.3% versus 0.1%, P=0.05) among individuals ≥80 years old. In patients ≥80 years old, higher odds of in-hospital MAE were observed in women (1.61-fold), and those with preprocedural congestive heart failure (≈2-fold), diabetes (≈1.5-fold), renal disease (≈2.6-fold), anemia (≈2.7-fold), and dementia (≈5-fold). In patients <80 years old, a higher risk of in-hospital MAE was encountered among women (≈1.4-fold) and those with diabetes (≈1.3-fold), renal disease (≈2.6-fold), anemia (≈2-fold), and dyslipidemia (≈1.2-fold). CONCLUSIONS: Patients ≥80 years old had higher rates of in-hospital MAE compared with patients aged <80 years old. Female sex and the presence of heart failure, diabetes, renal disease, and anemia were factors associated with in-hospital MAE among both groups.

Original languageEnglish (US)
Article numbere021973
JournalJournal of the American Heart Association
Volume10
Issue number19
DOIs
StatePublished - 2021
Externally publishedYes

Keywords

  • Anticoagulation
  • Atrial fibrillation
  • Comorbidities
  • Elderly
  • Left atrial appendage closure
  • Octogenarians
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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