In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians

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Background and aims: Data on safety outcomes of left atrial appendage occlusion (LAAO) in elderly patients are limited. This study aimed to compare the outcomes of LAAO between octogenarians (age 80-89) and nonagenarians (age ≥90) versus younger patients (age ≤79).

Methods: We conducted a retrospective cohort study using the National Inpatient Sample database to identify patients hospitalized for LAAO from 2016-2020 and to compare in-hospital safety outcomes in octogenarians and nonagenarians versus younger patients. The primary outcome was a composite of in-hospital all-cause mortality or stroke. Secondary outcomes included procedural complications, length of stay (LOS), and total costs. Outcomes were determined using logistic regression models.

Results: Among 84,140 patients hospitalized for LAAO, 32.9% were octogenarians, 2.8% were nonagenarians, and 64.3% were ≤79 years of age. Over the study period, the volume of LAAO increased in all age groups (all ptrend<0.01). After adjustment for clinical and demographic factors, octogenarians and nonagenarians had similar odds of in-hospital all-cause mortality or stroke (adjusted odds ratio [aOR] 1.41, 95% confidence interval [CI] 0.93-2.13 for octogenarians; aOR 1.69, 95% CI 0.67-3.92 for nonagenarians), cardiac tamponade, acute kidney injury, major bleeding, and blood transfusion, in addition to similar LOS and total costs compared with younger patients (all p>0.05). However, octogenarians and nonagenarians had higher odds of vascular complications (aOR 1.47, 95% CI 1.08-1.99 for octogenarians; aOR 1.60, 95% CI 1.18-2.97 for nonagenarians).

Conclusion: Octogenarians and nonagenarians undergoing LAAO have a similar safety profile compared with clinically similar younger patients except for a higher rate of vascular complications.

Keywords: Atrial fibrillation; LAAO; Nonagenarians; Octogenarians; Outcomes.