Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural...

Area of Science:

• Cardiology
• Health Disparities
• Medical Procedures

Background:

• Left atrial appendage occlusion (LAAO) is a crucial procedure for stroke prevention in atrial fibrillation.
• Non-white populations are underrepresented in LAAO clinical trials.
• Racial disparities in the periprocedural management of LAAO are not well understood.

Purpose of the Study:

• To investigate potential racial disparities in the periprocedural management of LAAO.
• To compare procedural wait times, complications, and post-procedure oral anticoagulation (OAC) use between white and non-white patients undergoing LAAO.

Main Methods:

• A retrospective analysis of consecutive patients undergoing LAAO between 2015 and 2020.
• Sociodemographic data and comorbidities were assessed.
• Adjusted analyses compared procedural wait times, complications, and OAC use based on race.

Main Results:

• Among 109 patients (45% white), white patients had lower CHA ₂ DS ₂ VASc scores than non-white patients (4.0 vs. 4.8, p=0.006).
• No significant differences were observed in procedural wait times or complication rates between racial groups.
• While OAC use at discharge trended higher in whites (OR 2.4, p=0.07), whites with a history of gastrointestinal (GI) bleed were nearly five-fold more likely to be discharged on OAC (OR 4.6, p=0.05), independent of income.

Conclusions:

• Wait times and procedural complications for LAAO were similar between white and non-white patients, despite higher comorbidity burden in non-whites.
• Significant racial disparities exist in post-procedure OAC prescribing, particularly for patients with a history of GI bleed.
• Further research is needed to address these disparities and ensure equitable care in LAAO management.