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Published on: February 26, 2013
Outcomes of Left Atrial Appendage Occlusion in Heart Failure With Reduced Ejection Fraction
Aamer Ubaid1, Arindam Bagga2, Kevin Kennedy3
1Department of Cardiovascular Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Insights
Patients with heart failure with reduced ejection fraction (HFrEF) undergoing left atrial appendage occlusion (LAAO) face increased risks of in-hospital complications and readmissions. This study highlights the need for careful consideration in this patient group.
Area of Science:
- Cardiology
- Medical Devices
- Health Outcomes Research
Background:
- Major trials on left atrial appendage occlusion (LAAO) excluded patients with heart failure with reduced ejection fraction (HFrEF).
- Understanding LAAO outcomes in HFrEF patients is crucial due to their distinct clinical profiles.
- HFrEF patients often present with higher cardiovascular comorbidity burdens.
Purpose of the Study:
- To characterize the population of patients undergoing LAAO with and without HFrEF.
- To evaluate and compare in-hospital adverse events and 6-month readmission rates after LAAO between HFrEF and non-HFrEF groups.
- To identify specific risks associated with LAAO in HFrEF patients.
Main Methods:
- Retrospective analysis of the Nationwide Readmissions Database (2016-2020).
- Inclusion of patients undergoing LAAO, stratified by HFrEF status.
- Risk-adjusted logistic regression and Cox proportional hazards models were used to compare outcomes, including major in-hospital adverse events and 6-month readmissions.
Main Results:
- 11.7% of 50,526 LAAO patients had HFrEF, exhibiting lower female proportion and higher cardiovascular comorbidities.
- HFrEF patients showed a significantly higher risk of composite in-hospital major adverse events (aOR 1.23).
- HFrEF was associated with increased 6-month risks for all-cause readmission (aHR 1.18), heart failure readmission (aHR 1.59), and readmission with death or stroke (aHR 1.27).
Conclusions:
- Approximately 1 in 9 patients receiving LAAO in the US has HFrEF.
- HFrEF is independently associated with increased risks of major in-hospital complications and subsequent hospital readmissions following LAAO.
- These findings underscore the importance of risk stratification and tailored management for HFrEF patients undergoing LAAO.
Background:
Patients with heart failure with reduced ejection fraction (HFrEF) were excluded from major trials of left atrial appendage occlusion (LAAO).
Aim:
The objective of this study was to describe this population and evaluate outcomes after LAAO in patients with and without HFrEF.
Methods:
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.
Results:
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).
Conclusion:
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.
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