Title

Outcomes and Predictors of Readmission after Implantation of a Percutaneous Left Atrial Appendage Occlusion device in the United States: A Propensity Score-matched Analysis from the National Readmission Database

Author Department

Internal Medicine; Medicine

Document Type

Article, Peer-reviewed

Publication Date

9-2021

Abstract

Background: LAAO devices have become a favorable alternative option among non-valvular atrial fibrillation (AF) patients with long-term contraindication to anticoagulation. Real-world experience with post-procedural readmission rates and predictors of readmission in LAAO patients is limited.

Objective: To assess all-cause 30-day readmission rate and predictors of readmission after Left atrial appendage occlusion (LAAO) procedure in the United States (US).

Method: This retrospective observational study included all AF patients undergoing percutaneous LAAO procedures in the US from January 1, 2016 and December 31, 2017 in the National Readmission Database. The primary outcome measure was all-cause 30-day readmission. A propensity score-matched analysis compared outcomes with a non-LAAO AF cohort.

Result: Among 14,024 LAAO procedures (age: 76 ± 8 years; 60.5% males), 9.4% were readmitted within 30-days and, 0.2% died during their index hospitalization. The most frequent primary diagnosis during readmission among LAAO was gastrointestinal bleeding (12%). The incidence of LAAO procedures increased by 102%. In multivariate model, gender and CHA2 DS2 -VASc failed to predict readmission. Age 55-64 years had lower odds (aOR: 0.41 95% CI 0.18-0.94), while drug abuse (aOR: 4.1 95% CI 1.34-12.54), and deficiency anemia (aOR: 1.88 95% CI 1.12-3.18) had higher odds of readmission. In propensity-matched cohort, compared to non-LAAO AF, LAAO patients had lower 30-day readmission (9.4% vs 10.98%, p=0.002) and all-cause in-hospital mortality (0.19% vs 0.57%, p<0.001).

Conclusion: The readmission rate following LAAO procedure is substantial (approximately 10%), and largely attributable to gastrointestinal bleeding. Factors such as drug abuse and anemia must be explored further to minimize readmission risk. This article is protected by copyright. All rights reserved.

Keywords: AF - Atrial Fibrillation; ECI - Elixhauser Comorbidity Index; ICD-10 - International Classification of Diseases; LAAO - Left Atrial Appendage Occlusion; NRD - National Readmission Database; Tenth Revision.

PMID

34535939

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