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Published on: February 26, 2013
Left atrial appendage occlusion: trends in demographics and in-hospital outcomes-a German nationwide analysis
Jakob Christoph Voran1,2, Hatim Seoudy1,2, Marius Leye3
1Department of Internal Medicine III, Cardiology and Critical Care, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
Insights
Left atrial appendage occlusion (LAAO) is increasingly used in older German patients, with men undergoing the procedure more frequently than women. Advanced age independently increases in-hospital mortality and MACE risks following LAAO.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Left atrial appendage occlusion (LAAO) serves as an interventional prophylactic treatment to prevent cardioembolic stroke in non-valvular atrial fibrillation patients.
- Understanding demographic trends and outcomes in LAAO procedures is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To investigate gender-specific differences in LAAO procedures within Germany.
- To analyze age-related trends and in-hospital outcomes for patients undergoing LAAO.
Main Methods:
- Retrospective analysis of German in-hospital cases from 2016-2022 using Diagnosis Related Groups (DRG) statistics.
- Inclusion criteria: patients with a coded LAAO procedure.
Main Results:
- A total of 40,435 LAAO procedures were analyzed; 39.2% of patients were female.
- The proportion of patients over 80 undergoing LAAO significantly increased from 28.3% in 2016 to 40.1% in 2022.
- In-hospital mortality and Major Adverse Cardiovascular Events (MACE) rates were significantly higher in older patient cohorts, particularly those over 85 years.
Conclusions:
- LAAO in Germany is increasingly performed in elderly individuals, with a notable gender disparity.
- Increasing age is an independent predictor of higher in-hospital MACE and mortality rates post-LAAO.
- Further prospective studies are warranted to balance the risks and benefits of LAAO as a preventive stroke strategy.
Background:
LAAO is an interventional, prophylactic treatment to prevent cardioembolic stroke in patients with non-valvular atrial fibrillation.
Aims:
The aim of this study was to assess gender differences and age-related in-hospital course of all patients undergoing left atrial appendage occlusion (LAAO) in Germany.
Methods:
The Research Data Center of the Federal Statistical Office accessed interrogation of its Diagnosis Related Groups (DRG) statistics database. In a retrospective observational manner, all German in-hospital cases from 2016 to 2022 with a coded LAAO procedure were analyzed.
Results:
LAAO was performed on a total of 40,435 patients, 39.2% of whom were female. The relative frequency of procedures in the German male population over the age of 60 was twice as high as in the German female population. The median age was 78 (IQR: 72-82) years. Compared to 28.3% in 2016, in 2022 40.1% of all patients were over 80 years of age (increased by 152%). Cases of patients over 85 years of age increased from 7.7 to 11.4% during the same time period. We found an in-hospital death rate for patients < 70, 70-75, 80-85 and > 85 years of age of 0.8, 1.0, 1.4 and 2.2% respectively. Further, we saw significantly higher MACE rates (< 75 years: 4%, 75-85 years: 5%, > 85 years: 7%) in patients with a higher age. Gender was not significantly associated with a higher rate of in-hospital mortality.
Conclusions:
In Germany, LAAO is increasingly performed in older patients with a strong gender imbalance. Age was independently associated with higher in-hospital MACE and mortality rates. This data provides a further basis to balance risks and benefits of LAAO as a preventive procedure and highlights the need for further prospective studies.
