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Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure
  1. Robbie Sparrow1,
  2. Shubrandu Sanjoy2,
  3. Yun-Hee Choi2,
  4. Islam Y Elgendy3,
  5. Hani Jneid4,
  6. Pedro A Villablanca5,
  7. David R Holmes6,
  8. Ashish Pershad7,
  9. Chadi Alraies8,
  10. Luciano A Sposato2,9,10,
  11. Mamas A Mamas11,
  12. Rodrigo Bagur2,10,11
  1. 1 Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  2. 2 Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  3. 3 Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
  4. 4 Division of Cardiology, Baylor College of Medicine and Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
  5. 5 Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
  6. 6 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  7. 7 The University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, USA
  8. 8 Department of Interventional Cardiology, Wayne State University, Detroit, Michigan, USA
  9. 9 Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, London, Ontario, Canada
  10. 10 London Health Sciences Centre, London, Ontario, Canada
  11. 11 Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Stoke, UK
  1. Correspondence to Dr Rodrigo Bagur, London Health Sciences Centre, Western University, London N6A 5A5, Canada; rodrigobagur{at}


Objective This manuscript aims to explore the impact of race/ethnicity and socioeconomic status on in-hospital complication rates after left atrial appendage closure (LAAC).

Methods The US National Inpatient Sample was used to identify hospitalisations for LAAC between 1 October 2015 to 31 December 2018. These patients were stratified by race/ethnicity and quartiles of median neighbourhood income. The primary outcome was the occurrence of in-hospital major adverse events, defined as a composite of postprocedural bleeding, cardiac and vascular complications, acute kidney injury and ischaemic stroke.

Results Of 6478 unweighted hospitalisations for LAAC, 58% were male and patients of black, Hispanic and ‘other’ race/ethnicity each comprised approximately 5% of the cohort. Adjusted by the older Americans population, the estimated number of LAAC procedures was 69.2/100 000 for white individuals, as compared with 29.5/100 000 for blacks, 47.2/100 000 for Hispanics and 40.7/100 000 for individuals of ‘other’ race/ethnicity. Black patients were ~5 years younger but had a higher comorbidity burden. The primary outcome occurred in 5% of patients and differed significantly between racial/ethnic groups (p<0.001) but not across neighbourhood income quartiles (p=0.88). After multilevel modelling, the overall rate of in-hospital major adverse events was higher in black patients as compared with whites (OR: 1.60, 95% CI 1.22 to 2.10, p<0.001); however, the incidence of acute kidney injury was higher in Hispanics (OR: 2.19, 95% CI 1.52 to 3.17, p<0.001). No significant differences were found in adjusted overall in-hospital complication rates between income quartiles.

Conclusion In this study assessing racial/ethnic disparities in patients undergoing LAAC, minorities are under-represented, specifically patients of black race/ethnicity. Compared with whites, black patients had higher comorbidity burden and higher rates of in-hospital complications. Lower socioeconomic status was not associated with complication rates.

  • atrial fibrillation
  • outcome assessment
  • health care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Twitter @islamelgendy83, @SposatoL, @MMamas1973, @RodrigoBagur

  • Contributors RS and RB conceived and designed the study. RS, Y-HC and RB analysed, interpreted the data and drafted the first version of the manuscript. All authors have interpreted the data, critically revised, provided intellectual contributions and approved the final version of the manuscript. RB is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DH is on the Advisory Board for Boston Scientific, unpaid.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.