Analysis of outcome of 6-month readmissions after percutaneous left atrial appendage occlusion

Abstract

Objective Percutaneous left atrial appendage occlusion (LAAO) is an alternative strategy for prevention of thromboembolic events in patients with atrial fibrillation and unsuitable for long-term oral anticoagulation. The study aimed to evaluate the causes and timing of readmissions within 6 months following percutaneous LAAO in a real-world setting. Methods We conducted a retrospective cohort study of percutaneous LAAO performed in the USA between January and June of 2016–2018 using the Nationwide Readmissions Database. Results Overall, 12\u2009446 patients who underwent LAAO were included in the analyses and 3477 patients (28%) were readmitted within 6 months following the interventions. Readmitted patients were more often women (p=0.001). The index hospitalisation was characterised by longer duration of hospital stay (p<0.001) and complicated with acute kidney injury (p<0.001) among readmitted patients compared with those without readmissions. Readmissions within 6 months following the index intervention were mainly due to heart failure (13%) and gastrointestinal bleeding (12%). Characteristics associated with readmissions due to heart failure included previously known heart failure (HR 2.39; 95% CI 1.70 to 3.37), valvular heart disease (HR 1.39; 95%\u2009CI 1.05 to 1.84) and chronic kidney disease (HR 1.42; 95%\u2009CI 1.03 to 1.94). Readmissions due to gastrointestinal bleeding were associated with diabetes mellitus (HR 1.78; 95%\u2009CI 1.25 to 2.53), chronic kidney disease (HR 1.86; 95%\u2009CI 1.23 to 2.81) and previous anaemia (HR 2.41; 95%\u2009CI 1.54 to 3.77). Conclusions After percutaneous LAAO, over a quarter of the patients in the USA required rehospitalisation within 6 months, mainly due to heart failure and gastrointestinal bleeding.