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Outcomes and Readmissions after Left Atrial Appendage Occlusion in Octogenarians: A Contemporary Analysis

Kirolos Barsoum1, Mahmoud Khalil2, Mohamed Magdi Eid3

  • 1University of Texas Medical Branch, Galveston, TX, USA.

Journal of the American Medical Directors Association
|August 27, 2023
PubMed

Insights

Left atrial appendage occlusion (LAAO) in octogenarians showed lower initial readmissions but increased gastrointestinal bleeding. Careful antithrombotic management is crucial for this elderly population.

Area of Science:

  • Cardiology
  • Medical Devices
  • Geriatric Medicine

Background:

  • Octogenarians were underrepresented in clinical trials for Left Atrial Appendage Occlusion (LAAO).
  • Understanding readmission causes and outcomes in this elderly group is vital for clinical practice.

Purpose of the Study:

  • To examine the causes and outcomes of readmission after LAAO in patients aged 80 years and older.
  • To compare readmission rates and causes between LAAO and anticoagulation (AC) in octogenarians.

Main Methods:

  • Retrospective cohort study using the National Readmission Database (2016-2018).
  • Identified patients aged ≥80 with atrial fibrillation or LAAO, excluding those who died during index admission.
  • Used ICD-10-CM codes and statistical analysis (Stata v17) including regression analysis to compare outcomes.

Main Results:

  • Out of 491,329 on AC and 2030 undergoing LAAO, all-cause readmissions were lower in the LAAO group at 45 days (P < .01).
  • Gastrointestinal bleeding (GIB) readmissions increased in the LAAO group at 45, 90, and 180 days (P < .01), but overall GIB rates were similar between groups.
  • No significant differences in stroke or intracranial hemorrhage rates were observed between LAAO and AC groups.

Conclusions:

  • LAAO in octogenarians is associated with an initial increase in GIB within 6 months, though not significantly different from AC long-term.
  • Antithrombotic strategies require careful consideration post-LAAO to mitigate bleeding risks in this vulnerable elderly population.
Abstract

Keywords:
Left atrial appendage closureOctageneriansatrial fibrillation

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