Frailty and associated outcomes in patients undergoing percutaneous left atrial appendage occlusion: findings from the NCDR LAAO registry

Darden, Douglas; Bilal Munir, M.; Zimmerman, Sarah; Eskander, Michael; Pothineni, Naga Venkata K.; Gopinathannair, Rakesh; Kabra, Rajesh; Lakkireddy, Dhanunjaya; Duong, Thao; Han, Frederick T.; Freeman, James V.; Hsu, Jonathan C.

doi:10.1007/s10840-023-01662-1

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…Occlusion of the left atrial appendage, the anatomic location most prone to thrombus formation due to AF-related stasis, has demonstrated similar rates of thromboembolism prevention compared with warfarin, with reduced risk of major bleeding [96]. This may represent an appealing strategy for frail older adults at high risk of fall-related bleeding; however, recent studies have demonstrated that, among older adults undergoing percutaneous left atrial appendage occlusion, frailty is associated with more procedural complications and higher 30-day and 1-year mortality rates [97][98][99]. Moreover, although older adults generally derive similar benefits from percutaneous left atrial appendage occlusion compared with younger adults, life expectancy should be taken into account in shared decision-making, as the long-term bleeding risk reduction may not outweigh the short-term procedural risk until approximately 2 years post-intervention [100,101].…”

Section: Stroke Prevention and Frailtymentioning

confidence: 99%

Assessment and Management of Atrial Fibrillation in Older Adults with Frailty

Rosas Diaz,

Troy,

Kaplinskiy

et al. 2024

Geriatrics

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Atrial fibrillation (AF) is a major driver of morbidity and mortality among older adults with frailty. Moreover, frailty is highly prevalent in older adults with AF. Understanding and addressing the needs of frail older adults with AF is imperative to guide clinicians caring for older adults. In this review, we summarize current evidence to support the assessment and management of older adults with AF and frailty, incorporating numerous recent landmark trials and studies in the context of the 2023 US AF guideline.

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Section: Stroke Prevention and Frailtymentioning

confidence: 99%

Assessment and Management of Atrial Fibrillation in Older Adults with Frailty

Rosas Diaz,

Troy,

Kaplinskiy

et al. 2024

Geriatrics

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Stroke prevention in atrial fibrillation: not a “one size fits all” endeavor

Peigh,

Passman

2023

J Interv Card Electrophysiol

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Incidence and predictors of 2-year mortality following percutaneous left atrial appendage occlusion in the EWOLUTION trial

Aarnink,

Ince,

Kische

et al. 2024

Europace

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Aims Sufficient survival time following left atrial appendage occlusion (LAAO) is essential for ensuring the efficacy and cost-effectiveness of this strategy for stroke prevention. Understanding prognostic factors for early mortality after LAAO could optimize patient selection. In the current study, we perform an in-depth analysis of 2-year mortality after LAAO, focusing particularly on potential predictors. Methods and results The EWOLUTION registry is a real-world cohort comprising 1020 patients that underwent LAAO. Endpoint definitions were pre-specified, and death was categorized as cardiovascular, non-cardiovascular, or unknown origin. Mortality rates were calculated from Kaplan–Meier estimates. Baseline characteristics significantly associated with death in univariate Cox regression analysis were incorporated into the multivariate analysis. All multivariate predictors were included in a risk model. Two-year mortality rate was 16.4% [confidence interval (CI): 14.0–18.7%], with 50% of patients dying from a non-cardiovascular cause. Multivariate baseline predictors of 2-year mortality included age [hazard ratio (HR) 1.05, CI: 1.03–1.08, per year increase], heart failure (HR 1.73, CI: 1.24–2.41), vascular disease (HR 1.47, CI: 1.05–2.05), valvular disease (HR 1.63, CI: 1.15–2.33), abnormal liver function (HR 1.80, CI: 1.02–3.17), and abnormal renal function (HR 1.58, CI: 1.10–2.27). Mortality rate exhibited a gradual rise as the number of risk factors increased, reaching 46.1% in patients presenting with five or six risk factors. Conclusion One in six patients died within 2 years after LAAO. We identified six independent predictors of mortality. When combined, this model showed a gradual increase in mortality rate with a growing number of risk factors, which may guide appropriate patient selection for LAAO. Clinical trial registration The original EWOLUTION registry was registered at clinicaltrials.gov under identifier NCT01972282.

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Frailty and associated outcomes in patients undergoing percutaneous left atrial appendage occlusion: findings from the NCDR LAAO registry

Cited by 3 publications

References 26 publications

Assessment and Management of Atrial Fibrillation in Older Adults with Frailty

Assessment and Management of Atrial Fibrillation in Older Adults with Frailty

Stroke prevention in atrial fibrillation: not a “one size fits all” endeavor

Incidence and predictors of 2-year mortality following percutaneous left atrial appendage occlusion in the EWOLUTION trial

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