Outcomes of Left Atrial Appendage Occlusion in Heart Failure With Reduced Ejection Fraction

Patients with heart failure with reduced ejection fraction (HFrEF) were excluded from major trials of left atrial appendage occlusion (LAAO).

The objective of this study was to describe this population and evaluate outcomes after LAAO in patients with and without HFrEF.

Patients with and without HFrEF undergoing LAAO were identified in the Nationwide Readmissions Database from 2016 to 2020. Outcomes of interest were major in-hospital adverse events (death, stroke, pericardial effusion, tamponade, pericardial window, transfusion) and 6-month readmissions (any readmission, heart failure readmission, death/stroke readmission). To account for differences between patients with and without HFrEF, outcomes were evaluated using risk-adjusted logistic regression models and risk-adjusted Cox proportional hazards models.

Of 50,526 encounters for LAAO, 5895 (11.7%) patients had HFrEF. The HFrEF group had a lower proportion of women and a higher proportion of major cardiovascular comorbidities. CHA₂DS₂-VASC score was 3.8 ± 1.3 in the HFrEF group and 3.7 ± 1.4 in those without HFrEF. HFrEF was associated with a higher risk of composite in-hospital major adverse events (6.0% vs. 5.0%, adjusted OR 1.23 [95% CI 1.09-1.40], p = 0.001) and a higher risk of 6-month all-cause readmission (adjusted HR 1.18 [95% CI 1.08-1.28], p < 0.001), heart failure readmission (adjusted HR 1.59 [95% CI 1.46-1.72], p < 0.001), and readmission with death or stroke (adjusted HR 1.27 [95% CI 1.03-1.57], p = 0.001).

One out of nine patients treated with LAAO in the United States has HFrEF, which is associated with a higher risk of major in-hospital complications and hospital readmission.