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Original research
Analysis of outcome of 6-month readmissions after percutaneous left atrial appendage occlusion
  1. Sae Morita1,
  2. Aaqib H Malik2,
  3. Toshiki Kuno3,
  4. Tomo Ando4,5,
  5. Risheek Kaul2,
  6. Srikanth Yandrapalli2,
  7. Alexandros Briasoulis6
  1. 1Department of Cardiology, Columbia University Medical Center, New York, New York, USA
  2. 2Department of Cardiology, Westchester Medical Center Health Network, Valhalla, New York, USA
  3. 3Department of Cardiology, Montefiore Medical Center, Bronx, New York, USA
  4. 4Internal Medicine, Kawasaki Saiwai Hospital, Kawasaki, Japan
  5. 5Department of Cardiology, Kawasaki Saiwai Hospital, Kawasaki, Japan
  6. 6Cardiovascular Diseases, University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr Sae Morita, Columbia University Medical Center, New York, NY 10032-3784, USA; abriasoulis{at}med.uoa.gr

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, 12 446 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% CI 1.05 to 1.84) and chronic kidney disease (HR 1.42; 95% CI 1.03 to 1.94). Readmissions due to gastrointestinal bleeding were associated with diabetes mellitus (HR 1.78; 95% CI 1.25 to 2.53), chronic kidney disease (HR 1.86; 95% CI 1.23 to 2.81) and previous anaemia (HR 2.41; 95% CI 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.

  • atrial fibrillation
  • outcome assessment
  • health care
  • heart failure

Data availability statement

Data are available in a public, open access repository.

Statistics from Altmetric.com

Data availability statement

Data are available in a public, open access repository.

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Footnotes

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  • SM and AHM contributed equally.

  • Contributors AHM and AB designed the study and were responsible for data collection. AHM and AB did the statistical analysis. SM, TK and AB interpreted the data and prepared the manuscript. TK, TA, SM and RK reviewed the manuscript and provided critical input. All authors contributed to reviewing or revising the manuscript and approved the final version.

  • 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 None declared.

  • Provenance and peer review Not commissioned; internally 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.

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