Racial and ethnic differences in left atrial appendage occlusion wait time, complications, and periprocedural management

Abstract

Purpose Non‐white patients are underrepresented in left atrial appendage occlusion (LAAO) trials, and racial disparities in LAAO periprocedural management are unknown. Methods We assessed sociodemographics and comorbidities of consecutive patients at our institution undergoing LAAO between 2015 and 2020, then in adjusted analyses, compared procedural wait time, procedural complications, and post‐procedure oral anticoagulation (OAC) use in whites versus non‐whites. Results Among 109 patients undergoing LAAO (45% white), whites had lower CHA2DS2VASc scores, on average, than non‐whites (4.0 vs. 4.8, p = .006). There was no difference in median time from index event (IE) or initial outpatient cardiology encounter to LAAO procedure (whites 10.5 vs. non‐whites 13.7 months, p = .9; 1.9 vs. 1.8 months, p = .6, respectively), and there was no difference in procedural complications (whites 4% vs. non‐whites 5%, p = .33). After adjusting for CHA2DS2VASc score, OAC use at discharge tended to be higher in whites (OR 2.4, 95% CI [0.9‐6.0], p = .07). When restricting the analysis to those with prior gastrointestinal (GI) bleed, adjusting for CHA2DS2VASc score and GI bleed severity, whites had a nearly five‐fold odds of being discharged on OAC (OR 4.6, 95% CI [1‐21.8], p = 0.05). The association between race and discharge OAC was not mediated through income category (total mediation effect 19% 95% CI [‐.04‐0.11], p = .38). Conclusion Despite an increased prevalence of comorbidities amongst non‐whites, wait time for LAAO and procedural complications were similar in whites versus non‐whites. Among those with prior GI bleed, whites were nearly five‐fold more likely to be discharged on OAC than non‐whites, independent of income.

Racial and Ethnic Differences in the Management of Atrial Fibrillation

“…57 Among those with prior GI bleeding, White patients were nearly five-fold more likely to be discharged on an OAC than non-White patients, independent of income. 58 Lower use of DOACs in Black and Hispanic patients has been reported in other studies. In the ORBIT-AF study, Black race, and Hispanic ethnicity relative to White race were associated with lower odds of being switched from warfarin to a DOAC.…”

“… 57 Among those with prior gastrointestinal bleeding, White patients were nearly 5-fold more likely to be discharged on an oral anticoagulant than were non-White patients, independent of income. 58 …”

Social determinants of access to timely elective surgery in Ontario, Canada: a cross-sectional population level study

“…The sizes of all the effects that were statistically significant were nevertheless small. In comparison, studies from the United States, [14][15][16][17] Aus tralia and New Zealand [18][19][20] have generally found nonwhite race and healthinsurance status to be associated with increased surgical wait times. In particular, minority groups had longer wait times for arthroplasty 14 and cholecystec tomy.…”