Association of advanced age with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: insights from the National Inpatient Sample of 36,065 procedures

Abstract

Background Age-stratified analyses of atrial fibrillation (AF) patients undergoing percutaneous left atrial appendage occlusion (LAAO) are limited. The purpose of current study was to compare in-hospital outcomes in elderly AF patients (age > 80 years) to a relatively younger cohort (age £ 80 years) after LAAO. Methods Data were extracted from National Inpatient Sample for calendar years 2015–2018. LAAO device implantations were identified on the basis of International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes of 37.90 and 02L73DK. The outcomes assessed in our study included complications, inpatient mortality, and resource utilization with LAAO. Results A total of 36,065 LAAO recipients were included in the final analysis, of which 34.6% (n=12,475) were performed on elderly AF patients. Elderly AF patients had a higher prevalence of major complications (6.7% vs. 5.7%, p < 0.01) and mortality (0.4% vs. 0.1%, p < 0.01) after LAAO device implantation in the crude analysis. After multivariate adjustment of potential confounders, age > 80 years was associated with increased risk of inpatient mortality (adjusted odds ratio [aOR] 4.439, 95% confidence interval [CI] 2.391–8.239) but not major complications (aOR 1.084, 95% CI 0.971–1.211), prolonged length of stay (aOR 0.943, 95% CI 0.88–1.101), or increased hospitalization costs (aOR 0.909, 95% CI 0.865–0.955). Conclusion Over 1 in 3 LAAO device implantations occurred in elderly AF patients. After adjusting for potential confounding variables, advanced age was associated with inpatient mortality, but not with other LAAO procedural–related outcomes including major complications, prolonged length of stay, or increased hospitalization costs.

Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies

“…Eighteen studies were excluded because no outcomes of interest were provided. Finally, 12 articles—11 observational studies and 1 analysis matched on propensity scores—were used in our study [ 14 , 15 , 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The characteristics of the study are shown in Table 1 .…”

“…Our meta-analysis showed that elderly patients had a higher risk of periprocedural mortality. Although only one study in our included study found a greater risk of death in the elderly group [ 14 ], this study was excluded by sensitive analysis, and the statistical results remained statistically significant. Only one study clearly gave the cause of death: one procedure-related death occurred the next day [ 17 ].…”

“…Third, patients from the United States who were undergoing LAAC were included in three studies. Two studies recruited patients from the National Inpatient Sample (NIS), but their age groupings were different, 75 and 80 years old [ 14 , 27 ]. One study included patients from the National Readmission Database (NRD) [ 26 ].…”

“…Due to the relatively small sample sizes of the existing studies, the results of LAAC for older individuals with AF remain inconsistent [ 14 , 15 , 16 , 17 ]. To address these problems, we carried out a meta-analysis of research examining the procedural safety and long-term effectiveness of LAAC for elderly patients with AF.…”

Left atrial appendage occlusion should be offered only to select atrial fibrillation patients

“… 15 , 16 In a study of 6779 patients undergoing percutaneous LAAO, Sanjoy and colleagues 61 showed that older patients (≥80 years old) had a higher rate of major adverse events compared to a younger LAAO cohort (6% vs 4.6%, P < .01). Our own work 62 assessed important outcomes of inpatient mortality and major complications after LAAO in patients aged ≥80 years and compared them to a cohort of patients aged <80 years. Outcomes depicted higher adjusted mortality in older patients undergoing LAAO compared to a relatively younger cohort (OR 4.44, 95% CI 2.39–8.24), but no significant adjusted risk of major complications, prolonged length of stay, and increased hospitalization costs.…”