Comorbidity burden in patients undergoing left atrial appendage closure

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Left atrial appendage closure (LAAC) is an alternative to anticoagulation for stroke prevention in atrial fibrillation.
• Patient populations undergoing LAAC often have significant comorbidities, influencing procedural outcomes.
• Understanding the relationship between comorbidity burden and in-hospital complications is crucial for risk stratification and patient selection.

Purpose of the Study:

• To evaluate the association between comorbidity burden and the risk of in-hospital major adverse events (MAE) following LAAC.
• To identify patient subgroups at higher risk for complications after LAAC.
• To inform clinical decision-making and improve patient safety in LAAC procedures.

Main Methods:

• A cohort-based observational study utilizing the US National Inpatient Sample database (October 2015 - December 2017).
• In-hospital MAE, defined as a composite of bleeding, acute kidney injury, vascular, cardiac complications, and stroke, was the primary outcome.
• Comorbidity burden and thromboembolic risk were assessed using Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Score (ECS), and CHA₂DS₂-VASc score. Logistic regression models were employed for analysis.

Main Results:

• A total of 3294 hospitalizations were analyzed, with a mean patient age of 75.7 years; 60% were male and 86% were white.
• The overall in-hospital MAE rate was 4.6%.
• Higher CCI (aOR: 1.19), ECS (aOR: 1.06), and CHA₂DS₂-VASc scores (aOR: 1.08) were significantly associated with increased MAE risk. Females and non-white patients also had approximately 1.5 times higher odds of MAE.

Conclusions:

• The majority of patients undergoing LAAC have a substantial comorbidity burden.
• In-hospital MAE occurred in 4.6% of LAAC procedures.
• Female sex, non-white race, and a higher comorbidity burden are significant risk factors for in-hospital MAE after LAAC.