Geographic and clinical patterns of left atrial appendage occlusion utilization across the United States

Left Atrial Appendage Occlusion (LAAO) has become a more common procedure designed to reduce stroke risk in patients who are intolerant of systemic anticoagulation. The speed of adoption and broader application to patients outside of the narrow trial patients motivates an assessment to understand whether specific operator characteristics affect procedural volume.

Using US CMS and Open Payments datasets, we explored LAAO procedural volumes, including temporal and geographical trends. We also examined how operator characteristics affected procedural volumes, including specialty, individual yearly procedural volume, and payments from LAAO manufacturers to clinicians.

LAAO procedural volume increased from 6,069 to 29,083 and 15 to 80 procedures per 100,000 enrollees from 2017 to 2021. Clinicians performing LAAO increased from 293 to 1038 and were primarily split between cardiac electrophysiology, interventional cardiology, and other cardiology subspecialties (48% Vs. 21% vs 26%, respectively, in 2021). There was a considerable geographic variation in procedural volume, with 46 states below 100 procedures per 100,000 enrollees. The highest-use state had over 250 LAAO procedures per 100,000 enrollees. Nearly all states saw an increase in procedural volume from 2017 to 2021. We found no meaningful correlation between payments from device manufacturers to clinicians and procedural volume.

We found a significant increase and high geographic variability in LAAO use throughout the United States. No clinically meaningful correlation existed between payments from LAAO manufacturers to clinicians and subsequent procedural volume.