Left atrial appendage closure device outcomes among cirrhosis patients with atrial fibrillation: a United States National Cohort Study

Abstract

Aims Literature regarding outcomes associated with atrial fibrillation among cirrhosis patients who had left atrial appendage occlusion (LAAO) device procedure is limited. We aim to evaluate the in-hospital clinical outcomes and 30-day readmissions among LAAO with and without cirrhosis. Methods and results We performed a retrospective study of all hospitalizations associated with the LAAO procedure, using the Nationwide Readmissions Database for the years 2016–19. Primary outcomes were in-hospital clinical outcomes and 30-day readmissions. A total of 54 897 index hospitalizations for LAAO (female 41.8%) were reported. Of these, 905(1.65%) had cirrhosis. Gastrointestinal (GI) bleeding was reported in 44 (4.9%) vs. 1606 (2.97%) and coagulopathy in 21 (2.3%) vs. 521 (0.96%) in cirrhosis and without-cirrhosis groups, respectively. A total of 872 (1.59%) patients needed blood transfusion, 24 (2.7%) vs. 848(1.57%) in cirrhosis vs. without-cirrhosis groups (P = 0.047). Fresh frozen plasma (FFP) transfusion was reported among 888 (1.62%), with cirrhosis 26 (3%) vs. without cirrhosis 862 (1.6%) (P = 0.05). On adjusted multivariate logistic regression analysis, acute kidney injury, coagulopathy, FFP transfusion, and blood transfusion were strongly associated with cirrhosis, and GI bleeding, ischaemic stroke, and intracranial haemorrhage were not associated with cirrhosis. Readmissions in 30 days were 5028 (9.18%), 167 (18.5%) in the cirrhosis group and 4861 (9%) without-cirrhosis group (P = 0.01). On multivariate Cox regression, CHA2DS2-Vasc score of six was significantly associated with 30-day readmission compared with other scores [hazard ratio 2.24; 95% confidence interval (1.58–3.16); P < 0.001]. Conclusion Left atrial appendage occlusion procedure in patients with cirrhosis had relatively similar GI bleeding and stroke rates, however, had higher rates of 30-day readmission. A higher CHA2DS2-Vasc score was more likely to be associated with 30-day readmissions and hence would help in discharge planning. The long-term safety and efficacy of LAAO in the cirrhosis population need to be demonstrated.

In-hospital safety outcomes of left atrial appendage occlusion in octogenarians and nonagenarians

“… 27–30 In a study evaluating the prognostic value of CKD in patients undergoing LAAO, moderate-to-severe CKD was associated with a higher incidence of the primary composite endpoint of cardiovascular mortality, thromboembolism, and major bleeding. 27 Similarly, among patients undergoing LAAO, the presence of heart failure was associated with prolonged LOS and higher hospitalization costs, 28 the presence of cirrhosis was associated with higher rates of 30-day readmission, 29 and the presence of a higher CHA 2 DS 2 -VASc score was associated with an increased risk of peri-procedural complications and resource utilization. 30 Female sex has also been associated with worse in-hospital outcomes following LAAO compared with men.…”

Diagnostic and therapeutic pathways for the malignant left atrial appendage: European Heart Rhythm Association physician survey

“… 16 , 17 It has emerged as a non-pharmacologic alternative to OAC, particularly in patients at high risk for major bleeding. 1 , 18 The PRAGUE-17 trial compared LAAO with DOAC in 402 patients with AF at high risk of stroke and bleeding and showed no inferiority in terms of the net clinical endpoint of thromboembolic complications and bleeding in follow-up for up to 4 years. 19 , 20 …”

Left atrial appendage occlusion in patients with cirrhotic liver disease: the importance of patient selection

“…In this edition of Europace , Mir and colleagues present a retrospective analysis of LAAO procedural outcomes in patients with cirrhosis compared to those without. 2 Using the National Readmissions Database, which covers almost half of all hospitalizations in the USA, the authors identified over 54 000 LAAO procedures performed between 2016 and 2019, of which 905 (1.65%) had cirrhosis. Patients with cirrhosis were younger, but had higher rates of comorbidities including heart failure, diabetes, obesity, chronic renal failure, cancer, and alcohol use as compared to those without.…”