Left Atrial Appendage Occlusion in the Elderly

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

“…25 In addition, in a recent study by Alkhouli et al , the average treatment effects of LAAO (compared with warfarin) were similar in the elderly population (compared with younger patients). 26 These findings of similar LAAO safety outcomes and treatment effects 26 have significant implications for evaluating the candidacy of patients based on age because; although elderly patients may be frailer, these findings suggest that they should not be excluded from undergoing LAAO based upon age alone if they are otherwise eligible for the procedure. However, certain comorbidities such as advanced chronic kidney disease (CKD), heart failure, and cirrhosis, and a higher CHA 2 DS 2 -VASc score have been shown to influence clinical outcomes of LAAO.…”

Cardiovascular Disease in the Older Adult

“…Seminal advances in diagnosis and treatment of AF in older adults since 1986 include: 1) development of risk scores for predicting stroke (eg, CHA 2 DS 2 -VASc) and bleeding (eg, HAS-BLED); 2) numerous randomized trials documenting the efficacy of oral anticoagulation for stroke prevention, including in patients of advanced age 30 ; 3) many trials comparing rate-control vs rhythm control, most of which have failed to demonstrate benefit from a rhythm control strategy; 4) catheter-based and surgical procedures for maintenance of sinus rhythm in selected patients; 5) novel direct-acting oral anticoagulants as alternatives to vitamin K antagonists 31 ; and 6) left atrial appendage occlusion as an alternative to anticoagulation in patients at high bleeding risk. 32 …”

Assessment and Management of Atrial Fibrillation in Older Adults with Frailty

“…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]. Notably, surgical left atrial appendage occlusion is indicated (Class 1A) for patients with AF and moderate-to-high stroke risk who are undergoing cardiac surgery for another reason [1].…”