Long-Term Outcomes Following Left Atrial Appendage Occlusion in Medicare Beneficiaries: Outcomes From the National...

Percutaneous left atrial appendage occlusion (LAAO) is an alternative to long-term anticoagulation for preventing ischemic stroke in patients with atrial fibrillation. There are limited long-term outcomes data for "real-world" patients undergoing LAAO.

We performed a retrospective cohort study using the National Cardiovascular Data Registry LAAO registry from January 1, 2016, through December 31, 2019. We linked LAAO data to inpatient Medicare fee-for-service claims data using probabilistic matching to establish a cohort of patients 65 years and older undergoing LAAO with a WATCHMAN device. The primary outcomes were any stroke and all-cause mortality.

A total of 34 975 patients with a mean±SD CHA₂DS₂-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, and sex category) score of 4.7±1.4 were included. The median follow-up was 2.8 years (interquartile range, 2.2-3.7 years). The cumulative incidence of any stroke was 1.57 per 100 person-years (95% CI, 1.45-1.70), with a 1-year and 5-year any stroke estimate of 1.70% (95% CI, 1.57-1.84%) and 5.70% (95% CI, 5.37-6.05%), respectively. The cumulative incidence of ischemic stroke was 1.36 per 100 person-years (95% CI, 1.25-1.48), with a 1-year and 5-year ischemic stroke estimate of 1.42% (95% CI, 1.30-1.54%) and 5.03% (95% CI, 4.71-5.36%), respectively. The cumulative incidence of death was 10.82 per 100 person-years (95% CI, 10.49-11.13), with a 5-year mortality estimate of 44.34% (95% CI, 43.35-45.23%).

Long-term stroke rates in a large nationally representative cohort of Medicare patients following LAAO were low and durably consistent during long-term follow-up despite a high thromboembolic risk. High mortality rates in this elderly population underscore the importance of incorporating patient values and preferences when considering LAAO.