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Jung M, Kim SW, Park JW. Trends in percutaneous left atrial appendage occlusion and 1-year mortality 2013-2021: A nationwide observational study. Int J Cardiol 2024; 410:132222. [PMID: 38823530 DOI: 10.1016/j.ijcard.2024.132222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Moonki Jung
- Heart and Brain Hospital, Chung-Ang University Gwangmyeong Center, Gwangmyeong and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Kim
- Heart and Brain Hospital, Chung-Ang University Gwangmyeong Center, Gwangmyeong and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jai-Wun Park
- Department of Cardiology, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany.
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Madsen OJ, Lamberts M, Olesen JB, Hansen ML, Kümler T, Grove EL, Andersen NH, Fosbøl E, De Backer O, Strange JE. Trends in percutaneous left atrial appendage occlusion and 1-year mortality 2013-2021: A nationwide observational study. Int J Cardiol 2024; 408:132098. [PMID: 38679168 DOI: 10.1016/j.ijcard.2024.132098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Percutaneous left atrial appendage occlusion (LAAO) is increasingly used for stroke prevention in patients with atrial fibrillation and anticoagulant-related complications. Yet, real-life studies evaluating changes in patient characteristics and indications for LAAO remain scarce. METHODS To evaluate changes in patient characteristics and indications for LAAO defined as 2-year history of intracerebral bleeding, any ischemic stroke/systemic embolism (SE), any non-intracerebral bleeding, other indication, and 1-year mortality. All patients undergoing percutaneous LAAO in Denmark from 2013 to 2021 were stratified into the following year groups: 2013-2015, 2016-2018, and 2019-2021. RESULTS In total, 1465 patients underwent LAAO. Age remained stable (2013-2015: 74 years versus 2019-2021: 75 years). Patients' comorbidity burden declined, exemplified by CHA2DS2-VASc ≥4 and HAS-BLED ≥3 decreased from 56.7% and 63.7% in 2013-2015 to 40.3% and 45.8% in 2019-2021. Indications for LAAO changed over time with other indication comprising 44.7% in 2019-2021; up from 26.9% in 2013-2015. Conversely, fewer patients had an indication of any ischemic stroke/SE (2013-2015: 30.8% vs 2019-2021: 20.3%) or any non-intracerebral bleeding (2013-2015: 29.4% vs 2019-2021: 23.4%). 1-year mortality was 11.3% for any non-intracerebral bleeding and 6.2% for other indication. CONCLUSION The LAAO patient-profile has changed considerably. Age remained stable, while comorbidity burden decreased during the period 2013-2021. LAAO is increasingly used in patients with no clinical event history and mortality differs according to indication. Selection of patients to LAAO should be done carefully, and contemporary real-life studies investigating clinical practice could add important insights.
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Affiliation(s)
- Olivia J Madsen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark.
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Jonas B Olesen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Morten L Hansen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark
| | - Thomas Kümler
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark; Complication Research, Steno Diabetes Center Copenhagen, Capital Region of Denmark, Denmark
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Niels H Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Galea R, Bini T, Krsnik JP, Touray M, Temperli FG, Kassar M, Papadis A, Gloeckler S, Brugger N, Madhkour R, Seiffge DJ, Roten L, Siontis GCM, Heg D, Windecker S, Räber L. Pericardial Effusion After Left Atrial Appendage Closure: Timing, Predictors, and Clinical Impact. JACC Cardiovasc Interv 2024; 17:1295-1307. [PMID: 38795087 DOI: 10.1016/j.jcin.2024.01.310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Pericardial effusion (PE) is the most common serious left atrial appendage closure (LAAC) complication, but its mechanisms, time course, and prognostic impact are poorly understood. OBJECTIVES This study sought to assess the frequency, timing, predictors and clinical impact of PE after LAAC. METHODS Data on consecutive patients undergoing percutaneous LAAC between 2009 and 2022 were prospectively collected including the 1-year follow-up. Both single (Watchman 2.5/FLX, Boston Scientific) and double (Amplatzer Cardiac Plug or Amulet, St. Jude Medical/Abbott) LAAC devices were used. An imaging core laboratory adjudicated the PEs and categorized them as early (≤7 days) and late (8-365 days). Logistic regression analysis was used to identify predictors of early and overall PE. RESULTS Of 1,023 attempted LAAC procedures, PE was observed in 44 (4.3%) patients; PE was categorized as early in 34 (3.3%) and late in 10 (0.9%) patients. The majority of PEs occurred within 6 hours after LAAC (n = 25, 56.8%) and were clinically relevant (n = 28, 63.6%). Independent predictors of early PE were double-closure left atrial appendage devices (adjusted OR: 8.20; 95% CI: 1.09-61.69), female sex (adjusted OR: 3.41; 95% CI: 1.50-7.73), the use of oral anticoagulation (OAC) at baseline (adjusted OR: 2.60; 95% CI: 1.11-6.09), and advanced age (adjusted OR: 1.07; 95% CI: 1.01-1.23), whereas female sex and OAC at baseline remained independent predictors of overall PE. CONCLUSIONS In this large LAAC registry, PE was observed in <1 in 20 patients and usually occurred within 6 hours after procedure. The majority of early PEs were clinically relevant and occurred in the Amplatzer Cardiac Plug/Amulet procedures. Independent predictors included the use of double-closure devices, female sex, OAC at baseline, and advanced age. (LAAC-registry: Clinical Outcome After Echocardiography-guided LAA-closure; NCT04628078).
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Affiliation(s)
- Roberto Galea
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tommaso Bini
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juan Perich Krsnik
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mariama Touray
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabrice Gil Temperli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohammad Kassar
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Athanasios Papadis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Steffen Gloeckler
- Department of Cardiology, Klinikum Hochrhei, Waldshut-Tiengen, Germany
| | - Nicolas Brugger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raouf Madhkour
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Julian Seiffge
- Department of Neurology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dierik Heg
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
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4
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Grimes K, Mehndiratta P, Chaturvedi S. The impact of sex on stroke care: From epidemiology to outcome. J Stroke Cerebrovasc Dis 2024; 33:107675. [PMID: 38467238 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Carotid stenosis and atrial fibrillation are key risk factors for development of hemispheric strokes. In this review we aim to identify sex-specific differences in the pathophysiology and treatment of these risk factors and areas for future study. KEY FINDINGS Women are underrepresented in research studies of stroke in patients with carotid disease and atrial fibrillation. However, key differences have been found between men and women that suggest that the development of carotid disease and atrial fibrillation occur at later stages of life and are associated with higher severity of stroke. Some treatments, including surgical treatment, seem to have different rates of efficacy and women and women are at higher risk of surgical complications. This suggests that treatment recommendations may need to be sex specific. CONCLUSION Efforts should be made to address research and treatment gaps in women with stroke risk factors. This may lead to the development of sex-specific recommendations for stroke prevention and treatment.
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Affiliation(s)
- Kathryn Grimes
- Department of Neurology & Stroke Program, University of Maryland School of Medicine
| | - Prachi Mehndiratta
- Department of Neurology & Stroke Program, University of Maryland School of Medicine
| | - Seemant Chaturvedi
- Department of Neurology & Stroke Program, University of Maryland School of Medicine.
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Swanson MJ, Uyeki CL, Yoder SR, Dhruva SS, Miller JE, Ross JS. Reporting of Demographics & Subgroup Analyses in Premarketing Studies of FDA Approved High-Risk Cardiovascular Devices, 2014-2022. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2024; 17:165-172. [PMID: 38707869 PMCID: PMC11067925 DOI: 10.2147/mder.s457152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/21/2024] [Indexed: 05/07/2024] Open
Abstract
Background Representation of diverse study populations in pivotal clinical trials for medical devices and subgroup analyses for demographic groups to explore differences in safety and effectiveness are essential to understanding the benefits and risks in diverse populations. The US Food and Drug Administration (FDA) has taken many steps to improve transparency and subgroup analyses over the past decade, but there has not been a recent evaluation of demographic reporting and subgroup analyses. Methods We reviewed all FDA Premarket Approvals for high-risk cardiovascular devices from 2014 to 2022, focusing on pivotal studies supporting device approval. We abstracted detailed demographic data about the age, sex, race, ethnicity, and socioeconomic position of study participants. We also assessed the presence and results of subgroup analyses to understand the safety and effectiveness of devices across trial populations. Results Analysis of 92 pivotal studies revealed that age and sex were reported in 96.7% of the studies, while race and ethnicity were reported in 71.7% and 58.7%, respectively. However, only 7.9% of studies explicitly detailed the participation of older adults (≥65 years) and no studies reported patients' socioeconomic position. Subgroup analyses by sex were conducted in 70.7% of studies, with 12.3% reporting significant differences. In contrast, analyses by race and ethnicity were performed in only 12.0% of the studies, with 9.1% reporting significant differences. Conclusion Approximately one-third of pivotal studies for high-risk cardiovascular devices approved by the FDA from 2014 to 2022 did not report the race of study participants, nearly 40% did not report ethnicity, and more than 90% did not report the participation of older adults (≥65 years). Subgroup analyses were infrequently conducted by age or race and ethnicity. There is a need for better trial demographic reporting and conduct of subgroup analyses in premarketing studies to ensure the safety and effectiveness of medical devices for all patients.
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Affiliation(s)
- Matthew J Swanson
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
- Leonard N. Stern School of Business, New York University, New York, NY, USA
| | - Colin L Uyeki
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Sarah R Yoder
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Sanket S Dhruva
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Joseph S Ross
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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Darden D, Bilal Munir M, Zimmerman S, Eskander M, Pothineni NVK, Gopinathannair R, Kabra R, Lakkireddy D, Duong T, Han FT, Freeman JV, Hsu JC. Frailty and associated outcomes in patients undergoing percutaneous left atrial appendage occlusion: findings from the NCDR LAAO registry. J Interv Card Electrophysiol 2024; 67:625-635. [PMID: 37858000 DOI: 10.1007/s10840-023-01662-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Frailty is associated with significant morbidity and mortality and may have clinical implications in an advanced age population with atrial fibrillation undergoing left atrial appendage occlusion (LAAO). We sought to develop a novel frailty scale to predict worse outcomes in patients undergoing LAAO. METHODS Patients in the NCDR LAAO Registry between 2016 and 2021 receiving percutaneous LAAO devices were categorized as non-frail (0 points), pre-frail (1-3 points), or frail (4-5 points) based on a 5-point scale representing multiple domains of frailty: hemoglobin <13.0 g/dL in male, <12.0 g/dL in female; creatinine ≥1.2 mg/dL; albumin <3.5 g/dL; body mass index <20 kg/m2; and increased risk of falls. RESULTS Of 57,728 patients, 44,360 (76.8%) were pre-frail and 7693 (13.3%) were frail. Compared to non-frail, pre-frail and frail patients were older, had a higher burden of co-morbidities, and more disability based on the Modified Rankin Scale. Compared to non-frail patients after adjustment, frail patients were at higher risk of in-hospital major complication (OR 1.29, 95% 1.02-1.62, p = 0.01), any complication (OR 1.29, 95% CI 1.09-1.52, p = 0.0005), and death (OR 5.79, 95% CI 1.75-19.17, p = 0.001), while no difference was observed in pre-frail patients. At 45-day follow-up, there was no difference in the risk of complications in frail patients as compared to non-frail, although mortality was significantly higher (OR 3.01, 95% CI 1.97-4.85, p < 0.0001). CONCLUSION A simple and practical frailty scale accurately predicts adverse events in patients undergoing LAAO. The 13% of patients considered frail were at significantly higher risk of in-hospital adverse events and 45-day mortality.
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Affiliation(s)
- Douglas Darden
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA.
| | - M Bilal Munir
- Division of Cardiology, Department of Medicine, University of California Davis, Sacramento, CA, USA
| | - Sarah Zimmerman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | | | - Rakesh Gopinathannair
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA
| | - Dhanunjaya Lakkireddy
- Kansas City Heart Rhythm Institute, 5100 W 110th St, Suite 200, Overland Park, KS, 66211, USA
| | - Thao Duong
- Midwest Heart and Vascular Specialists, HCA Midwest Health, Kansas City, MO, USA
| | - Frederick T Han
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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7
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Faridi KF, Ong EL, Zimmerman S, Varosy PD, Friedman DJ, Hsu JC, Kusumoto F, Mortazavi BJ, Minges KE, Pereira L, Lakkireddy D, Koutras C, Denton B, Mobayed J, Curtis JP, Freeman JV. Predicting Major Adverse Events in Patients Undergoing Transcatheter Left Atrial Appendage Occlusion. Circ Arrhythm Electrophysiol 2024; 17:e012424. [PMID: 38390713 PMCID: PMC11021146 DOI: 10.1161/circep.123.012424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/31/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry (LAAO) includes the vast majority of transcatheter LAAO procedures performed in the United States. The objective of this study was to develop a model predicting adverse events among patients undergoing LAAO with Watchman FLX. METHODS Data from 41 001 LAAO procedures with Watchman FLX from July 2020 to September 2021 were used to develop and validate a model predicting in-hospital major adverse events. Randomly selected development (70%, n=28 530) and validation (30%, n=12 471) cohorts were analyzed with 1000 bootstrapped samples, using forward stepwise logistic regression to create the final model. A simplified bedside risk score was also developed using this model. RESULTS Increased age, female sex, low preprocedure hemoglobin, no prior attempt at atrial fibrillation termination, and increased fall risk most strongly predicted in-hospital major adverse events and were included in the final model along with other clinically relevant variables. The median in-hospital risk-standardized adverse event rate was 1.50% (range, 1.03%-2.84%; interquartile range, 1.42%-1.64%). The model demonstrated moderate discrimination (development C-index, 0.67 [95% CI, 0.65-0.70] and validation C-index, 0.66 [95% CI, 0.62-0.70]) with good calibration. The simplified risk score was well calibrated with risk of in-hospital major adverse events ranging from 0.26% to 3.90% for a score of 0 to 8, respectively. CONCLUSIONS A transcatheter LAAO risk model using National Cardiovascular Data Registry and LAAO Registry data can predict in-hospital major adverse events, demonstrated consistency across hospitals and can be used for quality improvement efforts. A simple bedside risk score was similarly predictive and may inform shared decision-making.
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Affiliation(s)
- Kamil F. Faridi
- Section of Cardiovascular Medicine, Dept of Medicine, Yale School of Medicine
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | - Emily L. Ong
- Section of Cardiovascular Medicine, Dept of Medicine, Yale School of Medicine
| | - Sarah Zimmerman
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | - Paul D. Varosy
- Cardiology Section, VA Eastern Colorado Hlth Care System, Aurora, CO
| | | | - Jonathan C. Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Univ of California San Diego Health System, La Jolla, CA
| | - Fred Kusumoto
- Dept of Cardiovascular Disease, Mayo Clinic, Jacksonville, FL
| | - Bobak J. Mortazavi
- Dept of Computer Science & Engineering, Texas A&M Univ, College Station, TX
| | - Karl E. Minges
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | - Lucy Pereira
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | | | | | - Beth Denton
- American College of Cardiology, Washington, DC
| | | | - Jeptha P. Curtis
- Section of Cardiovascular Medicine, Dept of Medicine, Yale School of Medicine
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
| | - James V. Freeman
- Section of Cardiovascular Medicine, Dept of Medicine, Yale School of Medicine
- Ctr for Outcomes Rsrch & Evaluation, Yale New Haven Health, New Haven, CT
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Ye W, Zhou W, Zhao W, Mao J, Wang W, Wei L, Zhao L, Xu Y, Yu J, Fu Z, Wang Q, Zhang Z. Emergent surgical retrieval of a left atrial appendage occluder migrated into the left ventricular outflow tract with secondary massive mitral regurgitation: A case report and literature review. Heliyon 2024; 10:e27112. [PMID: 38449592 PMCID: PMC10915572 DOI: 10.1016/j.heliyon.2024.e27112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
Thrombotic complications of atrial fibrillation continue to pose a significant challenge in clinical practice today. Left atrial appendage occlusion (LAAO) has emerged as a promising alternative to oral anticoagulation for high-risk patients with atrial fibrillation. However, despite the potential benefits, there is still the possibility of life-threatening complications such as device dislocation. In this case study, we present a patient who experienced severe hemodynamic disturbances due to the embolization of LAAO device into the left ventricular outflow tract, resulting in a torn mitral valve and secondary massive mitral regurgitation, just 3 hours after the procedure. As a result, emergent surgical intervention was required to remove the device and repair the mitral valve. We also conducted a review of previous studies on the retrieval of dislodged left atrial appendage occluders through surgical procedures. It is crucial to maintain vigilance, foster interdisciplinary collaboration, and respond promptly to ensure the safety and efficacy of LAAO procedures.
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Affiliation(s)
- Wei Ye
- Department of Anesthesiology, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Anesthesiology, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Wei Zhou
- Department of Anesthesiology, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
| | - Weibing Zhao
- Department of Anesthesiology, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Anesthesiology, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Jingjing Mao
- Department of Anesthesiology, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Anesthesiology, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Wei Wang
- Heart and Great Vessels Center, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
| | - Liang Wei
- Cardiology Center, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Cardiology Center, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Linghui Zhao
- Cardiology Center, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Cardiology Center, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Yan Xu
- Department of Operating Room, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Operating Room, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Jing Yu
- Department of Operating Room, Huai'an Hospital Affiliated to Yangzhou University, Huai'an, Jiangsu, 223200, China
- Department of Operating Room, the Fifth People's Hospital of Huai'an, Huai'an, Jiangsu, 223200, China
| | - Zhi Fu
- Heart and Great Vessels Center, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
| | - Qiang Wang
- Heart and Great Vessels Center, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
- Yangzhou Institute of the Heart and Great Vessels, Yangzhou University, Yangzhou, Jiangsu, 225012, China
| | - Zhuan Zhang
- Department of Anesthesiology, the Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, 225012, China
- Yangzhou Institute of the Heart and Great Vessels, Yangzhou University, Yangzhou, Jiangsu, 225012, China
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9
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Lin KJ, Singer DE, Avorn J, Heist EK, Sreedhara SK, Anand P, Zhang Y, Tsacogianis TN, Schneeweiss S. Patient Characteristics Associated With Using Transcatheter Left Atrial Appendage Occlusion Versus Oral Anticoagulants for Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2024; 17:e010279. [PMID: 38440888 PMCID: PMC10950527 DOI: 10.1161/circoutcomes.123.010279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/30/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND Transcatheter left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation, but the predictors of LAAO use in routine care are unclear. We aimed to assess the utilization trends of LAAO and compare the change in characteristics of LAAO users versus OACs since its marketing. METHODS Using the US Medicare claims database (March 15, 2015, to December 31, 2020), we identified patients with atrial fibrillation, ≥65 years, and CHA2DS2-VASc score ≥2 (men) or ≥3 (women), with either first implantation of an LAAO device or initiation of OACs, including apixaban, dabigatran, rivaroxaban, edoxaban, or warfarin. Patient characteristics, measured 365 days before the first LAAO or OAC use date, were compared using logistic regression. RESULTS There were 30 058 LAAO recipients (mean age, 77.74 years; female, 42.1%) and 792 600 OAC initiators (mean age, 78.48; female, 53.3%). In 2020, patients had higher odds of initiating LAAO use than in 2015 (0.52 versus 9.32%; adjusted odds ratio [aOR], 13.64 [95% CI, 12.56-14.81]). Old age (ie, >85 versus 65-75 years; aOR, 0.84 [95% CI, 0.80-0.88]), female sex (aOR, 0.74 [95% CI, 0.71-0.76]), Black race (aOR, 0.63 [95% CI, 0.58-0.68]) versus White race, and Medicaid eligibility (aOR, 0.61 [95% CI, 0.58-0.64]) were associated with lower odds of receiving LAAO. Among clinical characteristics, frailty, cancer, fractures, and venous thromboembolism were associated with lower odds of LAAO use, while history of intracranial and extracranial bleeding, coagulopathy, and falls were associated with higher odds of receiving LAAO. CONCLUSIONS Among patients with atrial fibrillation receiving stroke-preventive therapy, LAAO use increased rapidly from 2015 to 2020 and was positively associated with the risk factors for OAC complications but negatively associated with old age, advanced frailty, and cancer. Black race and female sex were associated with a lower likelihood of receiving LAAO.
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Affiliation(s)
- Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School
| | - Daniel E Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School
| | - Jerry Avorn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
| | - E. Kevin Heist
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School
| | - Sushama Kattinakere Sreedhara
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
| | - Priyanka Anand
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
| | - Yichi Zhang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
| | - Theodore N. Tsacogianis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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11
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Aladin AI, Arar T, Lubaina F, Bhogal S, Zhang C, Wermers JP, Ben-Dor I, Satler LF, Rogers T, Slack M, Waksman R. Gender disparities related to clinical characteristics and outcomes of patients undergoing transseptal procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:45-49. [PMID: 37393190 DOI: 10.1016/j.carrev.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Explore gender disparities in patients undergoing transseptal puncture (TSP) for selected transcatheter cardiac intervention procedures. METHODS Patients who underwent TSP from January 2015 through September 2021 were reviewed. Primary outcomes were procedural and in-hospital major adverse events. Secondary endpoints were procedural success and hospitalization length of stay (LOS) >1 day. Unadjusted and multivariable-adjusted logistic regression analyses were performed to assess gender differences for in-hospital adverse events. RESULTS The study cohort comprised 510 patients (mean [SD] age, 74 [14.0] years); 246 women (48 %) underwent TSP for left atrial appendage occlusion (LAAO) or transcatheter edge-to-edge-repair (TEER). Compared with men, women were younger, had higher CHA2DS2-VASc scores, and were more likely to have had a prior ischemic stroke, but were less likely to have paroxysmal atrial fibrillation. After multivariable adjustment, there were no differences between genders in aborted or canceled procedures (odds ratio [OR]: 0.43; 95 % confidence interval [CI]: 0.10-1.96; p = 0.277), any adverse events (OR: 1.00; 95 % CI: 0.58-1.70; p = 0.98), major adverse events (OR: 1.60; 95 % CI: 0.90-2.80; p = 0.11), or death (OR: 1.00; 95 % CI: 0.20-5.00; p = 0.31). Subgroup analysis for LAAO procedures showed that at 30 days, women had higher rates of adverse events, major adverse cardiac events, and LOS >1 day. CONCLUSIONS Men and women showed no differences in procedural success and in-hospital adverse outcomes in unadjusted analysis and after multivariable adjustment, despite women having a higher risk profile among patients undergoing TSP. However, compared with men, women undergoing LAAO experienced a higher rate of in-hospital adverse events irrespective of TSP.
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Affiliation(s)
- Amer I Aladin
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Tareq Arar
- Department of Internal Medicine, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Fnu Lubaina
- Department of Internal Medicine, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Jason P Wermers
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institute of Health, Bethesda, MD, USA
| | - Michael Slack
- Division of Pediatric Cardiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Georgetown University/Washington Hospital Center, Washington, DC, USA.
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12
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Lu MLR, De Lurgio DB. Left atrial appendage closure: the journey today and tomorrow. Curr Opin Cardiol 2024; 39:20-26. [PMID: 37874028 DOI: 10.1097/hco.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
PURPOSE OF REVIEW This review aims to discuss the rationale behind the development of percutaneous LAAC devices as a treatment option for atrial fibrillation patients ineligible for long-term anticoagulation. The evolution of LAAC, from early experiences and challenges to risk mitigation and improved devices and techniques, will be examined. Furthermore, the review will explore our current understanding of the potential and limitations of LAAC in stroke prevention. RECENT FINDINGS Multiple trials confirm LAAC device safety and efficacy for stroke prevention, but peri-device leak and thrombus remain concerns postimplantation. Even small leaks pose increased stroke risk. While guidelines suggest short-term anticoagulation postimplant; real-world data show equivalent efficacy with dual antiplatelet regimen. SUMMARY LAAC device design has evolved and now serve as a viable option for stroke prevention in high-risk atrial fibrillation patients, offering protection in the absence of anticoagulation.
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13
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Agarwal S, Munir MB, Khan MZ, Bansal A, Deshmukh A, DeSimone CV, Stavrakis S, Asad ZUA. Impact of Psychosocial Risk Factors on Outcomes of Atrial Fibrillation Patients undergoing Left Atrial Appendage Occlusion Device Implantation. J Interv Card Electrophysiol 2023; 66:2031-2040. [PMID: 37016070 DOI: 10.1007/s10840-023-01546-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND The impact of psychosocial risk factors (PSRFs) on outcomes in patients undergoing percutaneous left atrial appendage occlusion (LAAO) device implantation is unclear. We aimed to analyze the association of psychosocial risk factors with outcomes in patients undergoing LAAO. METHODS Data were extracted from the Nationwide readmissions database for the calendar years 2016-2019. LAAO device implantations were identified using ICD-10-CM code 02L73DK. The outcomes of interest included procedural complications, inpatient mortality, resource utilization, and 30-day readmissions. Patients were divided into two cohorts based on the absence or presence of PSRFs. RESULTS Our cohort included a total of 54,900 patients, of which, 19,984 (36.4%) had ≥ 1 PSRF as compared to 34,916 (63.6%) with no PSRFs. The prevalence of major complications (3.3% vs 2.8%, p=0.03) was significantly higher in patients with ≥ 1 PSRF as compared to no PSRFs. Furthermore, patients with ≥ 1 PSRF had a significantly higher 30-day readmission rate (6.9% vs 6.2%, p=0.02). In the multivariable model, the presence of ≥ 1 PSRF was associated with significantly higher odds of overall complications [adjusted odds ratio (aOR):1.11; 95% confidence interval (CI): 1.01-1.21; p=0.02]. Additionally, the presence of ≥ 1 PSRF was associated with higher odds of prolonged hospital stay for more than one day (aOR: 1.30; 95% CI: 1.21-1.40; p<0.01). CONCLUSION The high prevalence of PSRFs may be associated with poorer outcomes in patients with AF patients undergoing LAAO device implantations. These data merit further study to help in the selection process of patients for LAAO for improved outcomes.
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Affiliation(s)
- Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Agam Bansal
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Stavros Stavrakis
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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14
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Sulague RM, Whitham T, Danganan LML, Effiom V, Candelario K, Latif N, Hameed I. The Left Atrial Appendage and Atrial Fibrillation-A Contemporary Review. J Clin Med 2023; 12:6909. [PMID: 37959374 PMCID: PMC10650862 DOI: 10.3390/jcm12216909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
In patients with atrial fibrillation, the left atrial appendage may serve as the site of thrombus formation due to stasis that occurs within the appendage because of its shape and trabeculations. Although thrombus formation can be reduced by using anticoagulants, this may be contraindicated in some patients. The need for a better alternative treatment prompted the study of left atrial appendage occlusion for thromboembolism prophylaxis. Due to this, procedures that excise or occlude the left atrial appendage have gained attention because of their ability to prevent thromboembolic events. This article provides a comprehensive review of the left atrial appendage and its associated procedures' clinical utility.
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Affiliation(s)
- Ralf Martz Sulague
- Graduate School of Arts and Sciences, Georgetown University, Washington, DC 20057, USA;
| | - Tarik Whitham
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA;
| | | | - Victory Effiom
- College of Medical Sciences, University of Calabar, Calabar 540271, Nigeria;
| | - Katherine Candelario
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA; (K.C.); (N.L.)
| | - Nida Latif
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA; (K.C.); (N.L.)
| | - Irbaz Hameed
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, New Haven, CT 06510, USA; (K.C.); (N.L.)
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15
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Tamirisa KP, Calvert P, Dye C, Mares AC, Gupta D, Al-Ahmad A, Russo AM. Sex Differences in Atrial Fibrillation. Curr Cardiol Rep 2023; 25:1075-1082. [PMID: 37505398 DOI: 10.1007/s11886-023-01927-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE OF REVIEW Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The estimated lifetime risk of developing AF is higher in men; however, due to differences in life expectancy, the overall prevalence is higher among women, particularly in the older age group. Sex differences play an important role in the pathophysiology, presentation, and clinical outcomes of AF. Awareness of these differences minimizes the potential for disparities in AF management. Our review summarizes the current literature on sex differences in AF, including the epidemiology, pathophysiology, risk factors, clinical symptomatology, mechanisms, treatment, and outcomes. We also explore the implications of these differences for clinical practice and future research. RECENT FINDINGS Women are more likely to present with atypical symptoms, have a higher stroke risk, and have a worse quality of life with AF when compared to men. Despite this, they are less likely to receive rhythm control strategies and anticoagulants. The sex-based differences in AF pathology and management might be a combination of inherent biological and hormonal differences, and implicit bias of the research entities and treating clinicians. Our review stresses the need for further sex-specific research in the pathophysiology of AF and opens a dialogue on personalized medicine, where management strategies can be tailored to individual patient characteristics, including sex.
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Affiliation(s)
- Kamala P Tamirisa
- Texas Cardiac Arrhythmia Institute, 11970 N. Central Expressway, Suite 540, Dallas/Austin, TX, USA.
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Cicely Dye
- Naval Medical Center, San Diego, CA, USA
| | | | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, 11970 N. Central Expressway, Suite 540, Dallas/Austin, TX, USA
| | - Andrea M Russo
- Cardiovascular Division, Cooper Medical School of Rowan University, Camden, NJ, USA
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16
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Alhuarrat MAD, Pargaonkar S, Rahgozar K, Safiriyu I, Zhang X, Faillace RT, Di Biase L. Comparison of in-hospital outcomes and complications of left atrial appendage closure with the Watchman device between males and females. Europace 2023; 25:euad228. [PMID: 37503957 PMCID: PMC10445300 DOI: 10.1093/europace/euad228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
AIMS Left atrial appendage occlusion (LAAO) with WATCHMAN device is being used for patients with atrial fibrillation (AFB) and, as an off-label use, atrial flutter (AFL) who can't comply with long-term anticoagulation. We aim to study the differences in outcomes between sexes in patients undergoing Watchman device implantation. METHODOLOGY The National Inpatient Sample was queried between 2016 and 2019 using ICD-10 clinical modification codes I48x for AFB and AFL. Patients who underwent LAAO were identified using the procedural code 02L73DK. Comorbidities and complications were identified using ICD procedure and diagnosis codes. Differences in primary outcomes were analyzed using multivariable regression and propensity score matching. RESULTS 38 105 admissions were identified, of which 16 795 (44%) were females (76 ± 7.6 years) and 21 310 (56%) were males (75 ± 8 years). Females were more likely to have cardiac (frequencies: 5.8% vs 3.75%, aOR: 1.5 [1.35-1.68], p1 day inpatient (1.79 [1.67-1.93], P < 0.01) and be discharged to a facility (1.54 [1.33-1.80], P < 0.01). CONCLUSION Females are more likely to develop cardiac, renal, bleeding, pulmonary and TEE-related complications following LAAO procedure, while concurrently showing higher mortality, length of stay and discharge to facilities.
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Affiliation(s)
- Majd Al Deen Alhuarrat
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY, USA
| | - Sumant Pargaonkar
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY, USA
| | - Kusha Rahgozar
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Israel Safiriyu
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY, USA
| | - Xiadong Zhang
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
| | - Robert T Faillace
- Division of Internal Medicine, Jacobi Medical Center, Albert Einstein College Medicine, Bronx, NY, USA
| | - Luigi Di Biase
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA
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17
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Thevathasan T, Degbeon S, Paul J, Wendelburg DK, Füreder L, Gaul AL, Scheitz JF, Stadler G, Rroku A, Lech S, Buspavanich P, Huemer M, Attanasio P, Nagel P, Reinthaler M, Landmesser U, Skurk C. Safety and Healthcare Resource Utilization in Patients Undergoing Left Atrial Appendage Closure-A Nationwide Analysis. J Clin Med 2023; 12:4573. [PMID: 37510689 PMCID: PMC10380523 DOI: 10.3390/jcm12144573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
Percutaneous left atrial appendage closure (LAAC) has emerged as a non-pharmacological alternative for stroke prevention in patients with atrial fibrillation (AF) not suitable for anticoagulation therapy. Real-world data on peri-procedural outcomes are limited. The aim of this study was to analyze outcomes of peri-procedural safety and healthcare resource utilization in 11,240 adult patients undergoing LAAC in the United States between 2016 and 2019. Primary outcomes (safety) were in-hospital ischemic stroke or systemic embolism (SE), pericardial effusion (PE), major bleeding, device embolization and mortality. Secondary outcomes (resource utilization) were adverse discharge disposition, hospital length of stay (LOS) and costs. Logistic and Poisson regression models were used to analyze outcomes by adjusting for 10 confounders. SE decreased by 97% between 2016 and 2019 [95% Confidence Interval (CI) 0-0.24] (p = 0.003), while a trend to lower numbers of other peri-procedural complications was determined. In-hospital mortality (0.14%) remained stable. Hospital LOS decreased by 17% (0.78-0.87, p < 0.001) and adverse discharge rate by 41% (95% CI 0.41-0.86, p = 0.005) between 2016 and 2019, while hospital costs did not significantly change (p = 0.2). Female patients had a higher risk of PE (OR 2.86 [95% CI 2.41-6.39]) and SE (OR 5.0 [95% CI 1.28-43.6]) while multi-morbid patients had higher risks of major bleeding (p < 0.001) and mortality (p = 0.031), longer hospital LOS (p < 0.001) and increased treatment costs (p = 0.073). Significant differences in all outcomes were observed between male and female patients across US regions. In conclusion, LAAC has become a safer and more efficient procedure. Significant sex differences existed across US regions. Careful considerations should be taken when performing LAAC in female and comorbid patients.
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Affiliation(s)
- Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Sêhnou Degbeon
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Julia Paul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Darius-Konstantin Wendelburg
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Lisa Füreder
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Anna Leonie Gaul
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Jan F Scheitz
- Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany
- Department of Neurology and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Gertraud Stadler
- Research Unit Gender in Medicine, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Andi Rroku
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany
| | - Sonia Lech
- Institute for Medical Sociology and Rehabilitation Science, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Pichit Buspavanich
- Research Unit Gender in Medicine, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
- Institute for Sexology and Sexual Medicine, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Philipp Attanasio
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Patrick Nagel
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Markus Reinthaler
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Potsdamer Str. 58, 10785 Berlin, Germany
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Paitazoglou C, Eitel I, Stiermaier T, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Vireca E, Wohlmuth P, Lucas B, Bergmann MW. Sex-related differences in outcome after left atrial appendage occlusion: Insights from Europe and the EWOLUTION registry. Catheter Cardiovasc Interv 2023. [PMID: 37393575 DOI: 10.1002/ccd.30759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/18/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Women with atrial fibrillation (AF) generally experience worse symptoms, poorer quality of life, and have a higher risk of stroke and death. There is limited availability of sex-related differences regarding left atrial appendage occlusion (LAAO). AIMS The aim of this study was to evaluate the sex-related differences in patients undergoing LAAO in EWOLUTION. METHODS A total of 1025 patients scheduled for elective LAAO therapy employing the WATCHMAN Gen 2.5 prospectively consented for participation; 1005 patients received a successful implant and were followed for 2 years. As we detected sex-related differences in baseline data we performed a propensity score matching. The primary endpoint is a combined endpoint of survival free from mortality, major bleeding, ischemic stroke, transitory ischemic attack (TIA) and systemic embolization (SE) up to 2-year clinical follow-up. Secondary Endpoints were periprocedural data and overall 2-year survival. RESULTS Women were older but had less often vascular disease and hemorrhagic stroke. There was no sex-related significant difference after LAAO at 2 years in the combined endpoint of survival free from mortality, major bleeding, ischemic stroke, TIA, and SE (female vs. male: 79% vs.76%, p = 0.24) or in overall survival (female vs. male: 85% vs. 82%, p = 0.16). Procedural data showed a higher sealing rate after the implantation in women (complete sealing female 94% vs. male 90%, p = 0.033), significantly more pericardial effusions (female 1.2% vs. male 0.2%, p = 0.031) and a similar periprocedural risk profile. CONCLUSIONS Females undergoing LAAO differ in various baseline variables, but after adjustment, we observed similar safety and efficacy of LAAO with no significant difference in long-term outcomes between women and men.
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Affiliation(s)
- Christina Paitazoglou
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Department Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH), University Heart Center Lübeck, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Hueseyin Ince
- Department of Cardiology, Vivantes Klinikum Neukölln and Klinikum Am Urban, Berlin, Germany
- Department of Cardiology, University Rostock, Rostock, Germany
| | - Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Evgeny Pokushalov
- Department of Cardiology, E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus, Essen, Germany
| | - Boris Schmidt
- Department of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Tommaso Gori
- Department of Cardiology, Universitätsmedizin Mainz und DZHK Standort Rhein-Main, Mainz, Germany
| | | | | | | | - Boersma Lucas
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Amsterdam UMV, Amsterdam, The Netherlands
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19
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Golemi L, Kumar S, Ahmad A, Ghani A, Srinivasamurthy R, Kumari S, Nasir A, Harjai K. Sex-Based Outcomes in Patients Undergoing WATCHMAN Device Implantation. Am J Cardiol 2023; 201:58-61. [PMID: 37352665 DOI: 10.1016/j.amjcard.2023.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/25/2023]
Abstract
Sex-based disparities in outcomes are reported for various cardiovascular procedures. This study aimed to assess the difference in outcomes in patients who underwent WATCHMAN device implant based on sex. Patients who underwent WATCHMAN device placement, from 2016 to 2018, were identified from the National Inpatient Sample database. The primary outcome was inpatient mortality, and the secondary outcomes were the length of stay (LOS), hospitalization cost (HOC), and periprocedural complications. A logistic regression model was built to perform an adjusted analysis for the outcomes. A total of 12,327 patients underwent WATCHMAN device placement. Female patients were older and more likely to have hypertension (p <0.01) and less likely to have peripheral arterial disease (5.6 vs 7.2, p <0.01), chronic kidney disease (21% vs 26%, p <0.01), and diabetes (18% vs 20%, p = 0.03) and were also at a higher risk for certain periprocedural complications, including pericardiocentesis and anemia requiring blood transfusion (p <0.01 for all). In the unadjusted analysis, the female sex was associated with longer LOS (1.5 vs 1.3 days, p <0.01) and inpatient mortality (0.23 vs 0.10, p = 0.05). The HOC was numerically higher in women but statistically nonsignificant ($120,791 vs $118,554, p = 0.1). In the stepwise, backward, multivariate regression analysis, the female sex was an independent risk factor for higher LOS (1.5 vs 1.3 days, p <0.01, 95% confidence interval 1.3 to 1.4) after adjusting for potential confounders. The inpatient mortality and HOC were similar between 2 groups after adjusting for potential cofounders in the multivariate regression analysis. Our study suggests that the female sex is an independent risk factor for longer LOS among patients hospitalized for WATCHMAN device placement.
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Affiliation(s)
- Lolita Golemi
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Sundeep Kumar
- Division of Cardiology, Case Western Reserve University, Cleveland, Ohio
| | - Ali Ahmad
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Ali Ghani
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | | | - Sarika Kumari
- Division of Cardiology, Jinnah Post Graduate Medical Center, Karachi, Pakistan
| | - Ammar Nasir
- Division of Cardiology, St. Louis University Hospital, St. Louis, Missouri
| | - Kishore Harjai
- Division of Cardiology, St. Louis University Hospital, St. Louis, Missouri.
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20
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Ng AP, Chervu N, Sanaiha Y, Vadlakonda A, Kronen E, Benharash P. Sociodemographic disparities in concomitant left atrial appendage occlusion during cardiac valve operations. PLoS One 2023; 18:e0286337. [PMID: 37228108 DOI: 10.1371/journal.pone.0286337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Sociodemographic disparities in atrial fibrillation (AF) management and thromboembolic prophylaxis have previously been reported, which may involve inequitable access to left atrial appendage occlusion (LAAO) during cardiac surgery. The present study aimed to evaluate the association of LAAO utilization with sex, race, and hospital region among patients with AF undergoing heart valve operations. METHODS Adults with AF undergoing valve replacement/repair in the 2012-2019 National Inpatient Sample were identified and stratified based on concurrent LAAO. Multivariable linear and logistic regressions were developed to identify factors associated with LAAO utilization. Mortality, complications including stroke and thromboembolism, hospitalization costs and length of stay (LOS) were secondarily assessed. RESULTS Of 382,580 patients undergoing valve operations, 18.7% underwent concomitant LAAO. Over the study period, the proportion of female patients receiving LAAO significantly decreased from 44.8% to 38.9% (p<0.001). Upon risk adjustment, female (AOR 0.93 [95% CI 0.89-0.97]) and Black patients (0.91 [0.83-0.99]) had significantly reduced odds of undergoing LAAO compared to males and Whites, respectively. Additionally, hospitals in the Midwest (1.38 [1.24-1.51]) and West (1.26 [1.15-1.36]) had increased likelihood of LAAO whereas Northeast hospitals (0.85 [0.77-0.94)] had decreased odds relative to the South. Furthermore, LAAO was associated with decreased stroke (0.71 [0.60-0.84]) and thromboembolism (0.68 [0.54-0.86]), $4,200 reduction in costs and 1-day decrement in LOS. CONCLUSIONS Female and Black patients had significantly lower odds while Midwest and Western hospitals had greater odds of LAAO utilization. Enhancing access to LAAO during valvular surgery is warranted to improve clinical and financial outcomes for patients with AF.
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Affiliation(s)
- Ayesha P Ng
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Elsa Kronen
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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21
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Ko D, Bostrom JA, Qazi S, Kramer DB, Kim DH, Orkaby AR. Frailty and Cardiovascular Mortality: A Narrative Review. Curr Cardiol Rep 2023; 25:249-259. [PMID: 36795307 PMCID: PMC10130976 DOI: 10.1007/s11886-023-01847-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE OF REVIEW The goal of the narrative review is to provide an overview of the epidemiology of frailty in cardiovascular disease and cardiovascular mortality and discuss applications of frailty in cardiovascular care of older adults. RECENT FINDINGS Frailty is highly prevalent in older adults with cardiovascular disease and is a robust, independent predictor of cardiovascular death. There is a growing interest in using frailty to inform management of cardiovascular disease either through pre- or post-treatment prognostication or by delineating treatment heterogeneity in which frailty serves to distinguish patients with differential harms or benefits from a given therapy. Frailty can enable more individualized treatment in older adults with cardiovascular disease. Future studies are needed to standardize frailty assessment across cardiovascular trials and enable implementation of frailty assessment in cardiovascular clinical practice.
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Affiliation(s)
- Darae Ko
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - John A Bostrom
- Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Saadia Qazi
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel B Kramer
- Richart A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, USA
| | - Ariela R Orkaby
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA.
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
- New England GRECC (Geriatric Research, Education, and Clinical Center) VA Boston Healthcare System, 150 South Huntington, 02130, Boston, MA, USA.
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22
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Trohman RG, Huang HD, Sharma PS. Atrial fibrillation: Primary prevention, secondary prevention, and prevention of thromboembolic complications: Part 2. Front Cardiovasc Med 2023; 9:1060096. [PMID: 36969508 PMCID: PMC10036779 DOI: 10.3389/fcvm.2022.1060096] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/14/2022] [Indexed: 03/12/2023] Open
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, once thought to be benign as long as the ventricular rate was controlled, is associated with significant cardiac morbidity and mortality. Increasing life expectancy driven by improved health care and decreased fertility rates has, in most of the world, resulted in the population aged ≥65 years growing more rapidly than the overall population. As the population ages, projections suggest that the burden of AF may increase more than 60% by 2050. Although considerable progress has been made in the treatment and management of AF, primary prevention, secondary prevention, and prevention of thromboembolic complications remain a work in progress. This narrative review was facilitated by a search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1950 and 2021. Atrial fibrillation was searched using the terms primary prevention, hyperthyroidism, Wolff-Parkinson-White syndrome, catheter ablation, surgical ablation, hybrid ablation, stroke prevention, anticoagulation, left atrial occlusion and atrial excision. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. In these two manuscripts, we discuss the current strategies available to prevent AF, then compare non-invasive and invasive treatment strategies to diminish AF recurrence. In addition, we examine the pharmacological, percutaneous device and surgical approaches to prevent stroke as well as other types of thromboembolic events.
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23
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Albert E, Puscas T, Seret G, Tence N, Amet D, Varlet E, M'Barek DR, Picard F, Otmani A, Sabbah L, Le Guen J, Bodiguel E, Domigo V, Soulat G, Spaulding C, Marijon E. Initiation and development of a percutaneous left atrial appendage closure programme: A French centre's experience and literature review. Arch Cardiovasc Dis 2023; 116:136-144. [PMID: 36797076 DOI: 10.1016/j.acvd.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/18/2022] [Accepted: 12/20/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Percutaneous left atrial appendage closure may be considered in selected patients with atrial fibrillation at significant risk of both thromboembolism and haemorrhage. AIMS To report the experience of a tertiary French centre in percutaneous left atrial appendage closure and to discuss the outcomes compared with previously published series. METHODS This was a retrospective observational cohort study of all patients referred for percutaneous left atrial appendage closure between 2014 and 2020. Patient characteristics, procedural management and outcomes were reported, and the incidence of thromboembolic and bleeding events during follow-up were compared with historical incidence rates. RESULTS Overall, 207 patients had left atrial appendage closure (mean age 75.3±8.6 years; 68% men; CHA2DS2-VASc score 4.8±1.5 ; HAS-BLED score 3.3±1.1), with a 97.6% (n=202) success rate. Twenty (9.7%) patients had at least one significant periprocedural complication, including six (2.9%) tamponades and three (1.4%) thromboembolisms. Periprocedural complication rates decreased from earlier to more recent periods (from 13% before 2018 to 5.9% after; P=0.07). During a mean follow-up of 23.1±20.2 months, 11 thromboembolic events were observed (2.8% per patient-year), a 72% risk reduction compared with the estimated theoretical annual risk. Conversely, 21 (10%) patients experienced bleeding during follow-up, with almost half of the events occurring during the first 3 months. After the first 3 months, the risk of major bleeding was 4.0% per patient-year, a 31% risk reduction compared with the expected estimated risk. CONCLUSION This real-world evaluation emphasizes the feasibility and benefit of left atrial appendage closure, but also illustrates the need for multidisciplinary expertise to initiate and develop this activity.
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Affiliation(s)
- Emeric Albert
- Université Paris Cité, Inserm, PARCC, 75015 Paris, France; Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Tania Puscas
- Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Gabriel Seret
- Université Paris Cité, Inserm, PARCC, 75015 Paris, France; Department of Cardiology, Cochin Hospital, AP-HP, 75015 Paris, France
| | - Noémie Tence
- Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Denis Amet
- Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Emilie Varlet
- Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Dorra Raboudi M'Barek
- Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Fabien Picard
- Université Paris Cité, Inserm, PARCC, 75015 Paris, France; Department of Cardiology, Cochin Hospital, AP-HP, 75015 Paris, France
| | - Akli Otmani
- Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Laurent Sabbah
- Department of Cardiology, Necker Hospital, AP-HP, 75015 Paris, France
| | - Julien Le Guen
- Department of Geriatry, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Eric Bodiguel
- Department of Neurology, Saint Anne Hospital, Université Paris-Cité, 75014 Paris, France; Emergency Department, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Valerie Domigo
- Department of Neurology, Saint Anne Hospital, Université Paris-Cité, 75014 Paris, France
| | - Gilles Soulat
- Université Paris Cité, Inserm, PARCC, 75015 Paris, France; Department of Radiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Christian Spaulding
- Université Paris Cité, Inserm, PARCC, 75015 Paris, France; Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Eloi Marijon
- Université Paris Cité, Inserm, PARCC, 75015 Paris, France; Department of Cardiology, Georges Pompidou European Hospital, AP-HP, 75015 Paris, France.
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24
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Hana D, Miller T, Chaker Z, Chobufo MD, Khan A, Patel B, Ghobrial J, Kawsara A, Thompson J, Raybuck B, Badhwar V, Daggubatti R, Mills J, Hamirani YS. Evaluating Gender-based Differences in Clinical Outcomes for Patients Undergoing Left Atrial Appendage Occlusion: A Single Centre Experience. Curr Probl Cardiol 2023; 48:101532. [PMID: 36509198 DOI: 10.1016/j.cpcardiol.2022.101532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
There is emerging recent data that has shown women to be more prone to in-hospital major adverse events after trans catheter left atrial appendage occlusion. Institutional LAAO registry at West Virginia University (WVU) was reviewed from January 2016 to October 2021 to identify 271 women and 293 men who underwent successful LAAO device implantation. Patients were evaluated for gender-based differences in baseline characteristics, CHA₂DS₂-VASc Score, HAS-BLED score, procedural data, in-hospital, and follow-up outcomes. Compared to men, women had lower baseline comorbidities including coronary artery disease (135 (49.6%) vs 172 (58.7%), P = 0.03), myocardial infarction (MI) (56 (20.5%) vs 85 (29%), P = 0.02) and coronary artery bypass surgery (10 (3.6%) vs 27 (9.2%), P = 0.008). Women were noted to have a higher CHA₂DS₂-VASc Score (5.3 ± 1.4 vs 4.4 ± 1.4, P < 0.001), and left ventricular ejection fraction (57.9 ± 7.7 vs 52.7 ± 12.4, P < 0.001). Women were noted to have a significantly higher rate of in-hospital composite adverse events (74 (27.2%) vs 58 (19.8%), P = 0.03); bleeding events (38 (10.2%) vs 19 (6.4%), P = 0.003) and associated blood transfusion (6 vs 0, P = 0.001) compared with men. No statistically significant differences were noted between both genders regarding the follow-up outcome. Our single center study shows women to have higher in-hospital composite adverse events as well as higher bleeding events during the index hospital admission.
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Affiliation(s)
- David Hana
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Tyler Miller
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Zakeih Chaker
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Muchi D Chobufo
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Arsalan Khan
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Bansari Patel
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Jonathan Ghobrial
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Akram Kawsara
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Jesse Thompson
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Bryan Raybuck
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, WV
| | - Ramesh Daggubatti
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - James Mills
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV
| | - Yasmin S Hamirani
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV.
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25
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Mathai SV, Sohal S, Flatow E, Nagaraj S, Hajra A, Chugh Y, Palaiodimos L, Lee HJ, Ansari J, Cohen M, Volgman AS, Faillace R. Sex Differences in Periprocedural and Long-Term Outcomes Following Transcatheter Left Atrial Appendage Occlusion: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 48:23-31. [PMID: 36336589 DOI: 10.1016/j.carrev.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is among the most common arrhythmias associated with an increased risk of cardioembolic phenomena, including stroke. Percutaneous left atrial appendage occlusion (LAAO) has proven beneficial in reducing stroke and mortality in patients with atrial fibrillation who have contraindications to anticoagulation. However, the sex differences in outcomes following LAAO have not been studied systematically. METHODS Electronic databases PUBMED, Embase, and Web of Science were systematically searched until March 2022 for studies evaluating patient outcomes following LAAO for AF. The primary outcomes of interest were the risks of periprocedural stroke, major bleeding, pericardial complications, and all-cause mortality. Secondary outcomes included stroke risks, major bleeding, device-related thrombus, cardiovascular and all-cause mortality on long-term follow-up. A random-effects model meta-analysis was conducted, and heterogeneity was assessed using the I-squared test. RESULTS Sixteen studies were included in the final analysis encompassing 111,775 patients, out of which 45,441 (40.7 %) were women. Women had a significantly higher risk of peri-procedural complications including all-cause mortality [relative risk (RR), 95 % confidence intervals (CI); RR 1.94, 95 % CI 1.40-2.69], stroke [RR 1.85, 95 % CI 1.29-2.67], major bleeding [RR 1.63, 95 % CI 1.08-2.44], and pericardial events [RR 1.80, 95 % CI 1.58-2.05]. However, there were no statistically significant differences between sexes in terms of risk of stroke, major bleeding, device-related thrombus, cardiovascular and all-cause mortality on long-term follow-up. CONCLUSION Among patients undergoing LAAO implantation, women were at higher risk of periprocedural complications than men. This risk was not significant on long-term follow-up.
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Affiliation(s)
- Sheetal Vasundara Mathai
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America.
| | - Sumit Sohal
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Elie Flatow
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Sanjana Nagaraj
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Adrija Hajra
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Yashasvi Chugh
- Division of Interventional and Structural Cardiology, Department of Medicine, Minneapolis Heart Institute, Minneapolis, MN, United States of America
| | - Leonidas Palaiodimos
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
| | - Hyon Jae Lee
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Julia Ansari
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Marc Cohen
- Division of Cardiology, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ 07112, United States of America
| | - Annabelle Santos Volgman
- Division of Cardiology, Department of Medicine, Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, United States of America
| | - Robert Faillace
- Department of Medicine, NYC Health +Hospitals/Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY 10461, United States of America
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26
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1194] [Impact Index Per Article: 1194.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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27
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Zeitler EP, Kearing S, Coylewright M, Nair D, Hsu JC, Darden D, O'Malley AJ, Russo AM, Al-Khatib SM. Comparative Effectiveness of Left Atrial Appendage Occlusion Versus Oral Anticoagulation by Sex. Circulation 2023; 147:586-596. [PMID: 36780379 DOI: 10.1161/circulationaha.122.062765] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/06/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The comparative real-world outcomes of older patients with atrial fibrillation (AF) treated with anticoagulation compared with left atrial appendage occlusion (LAAO) may be different from those in clinical trials because of differences in anticoagulation strategies and patient demographics, including a greater proportion of women. We sought to compare real-world outcomes between older patients with AF treated with anticoagulation and those treated with LAAO by sex. METHODS Using Medicare claims data from 2015 to 2019, we identified LAAO-eligible beneficiaries and divided them into sex subgroups. Patients receiving LAAO were matched 1:1 to those receiving anticoagulation alone through propensity score matching. The risks of mortality, stroke or systemic embolism, and bleeding were compared between matched groups with adjustment for potential confounding characteristics in Cox proportional hazards models. RESULTS Among women, 4085 LAAO recipients were matched 1:1 to those receiving anticoagulation; among men, 5378 LAAO recipients were similarly matched. LAAO was associated with a significant reduction in the risk of mortality for women and men (hazard ratio [HR], 0.509 [95% CI, 0.447-0.580]; and HR, 0.541 [95% CI, 0.487-0.601], respectively; P<0.0001), with a similar finding for stroke or systemic embolism (HR, 0.655 [95% CI, 0.555-0.772]; and HR, 0.649 [95% CI, 0.552-0.762], respectively; P<0.0001). Bleeding risk was significantly greater in LAAO recipients early after implantation but lower after the 6-week periprocedural period for women and men (HR, 0.772 [95% CI, 0.676-0.882]; and HR, 0.881 [95% CI, 0.784-0.989], respectively; P<0.05). CONCLUSIONS In a real-world population of older Medicare beneficiaries with AF, compared with anticoagulation, LAAO was associated with a reduction in the risk of death, stroke, and long-term bleeding among women and men. These findings should be incorporated into shared decision-making with patients considering strategies for reduction in AF-related stroke.
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Affiliation(s)
- Emily P Zeitler
- Dartmouth Health (E.P.Z., S.K.), Lebanon, NH
- Dartmouth Institute, Lebanon, NH (E.P.Z., A.J.O.)
| | | | | | - Devi Nair
- St. Bernard's Heart and Vascular Center, Jonesboro, AR (D.N.)
| | | | - Douglas Darden
- Kansas City Heart Rhythm Institute, Overland Park (D.D.)
| | - A James O'Malley
- Dartmouth Institute, Lebanon, NH (E.P.Z., A.J.O.)
- Geisel School of Medicine at Dartmouth College, Hanover, NH (A.J.O.)
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (S.M.A.-K.)
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Chen M, Sun J, Li W, Zhang PP, Zhang R, Mo BF, Yang M, Wang QS, Li YG. Sex Differences in the Combined Ablation and Left Atrial Appendage Closure: Results From LAACablation Registry. JACC. ASIA 2023; 3:138-149. [PMID: 36873751 PMCID: PMC9982225 DOI: 10.1016/j.jacasi.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/19/2022] [Accepted: 10/08/2022] [Indexed: 01/18/2023]
Abstract
Background More than 40% of left atrial appendage closure (LAAC) procedures were combined with atrial fibrillation (AF) ablation in China. Objectives This study aimed to assess the sex differences in the combined radiofrequency catheter ablation and LAAC procedures. Methods Data from the LAACablation (Left Atrial Appendage Closure in Combination With Catheter Ablation) registry, which enrolled AF patients who underwent the combined procedure between 2018 and 2021, were analyzed. Procedural complications, long-term outcomes, and quality of life (QoL) were compared between sexes. Results Of 931 patients, 402 (43.2%) were women. Compared with men, women were older (age 71.3 ± 7.4 years vs 68.7 ± 8.1 years; P < 0.001), presented more often with paroxysmal AF (52.5% vs 42.7%; P < 0.003), and had higher CHA2DS2-VASc scores (4.1 ± 1.5 vs 3.1 ± 1.5; P < 0.001), but received less often linear ablation and had shorter total procedural times and radiofrequency catheter ablation times. Women had similar rates of total and major procedural complications but presented with a higher incidence of minor complications than men (3.7% vs 1.3%; P = 0.027). Follow-up over 1,812 patient-years revealed similar adverse events between women and men, including all-cause death (HR: 0.89; 95% CI: 0.43-1.85; P = 0.754), thromboembolic events (HR: 1.17; 95% CI: 0.54-2.52; P = 0.697), major bleeding (HR: 0.96; 95% CI: 0.38-2.44; P = 0.935), and their composite (HR: 0.85; 95% CI: 0.56-1.28; P = 0.434). The recurrence rates of atrial tachyarrhythmia were also comparable between sexes presenting either paroxysmal or persistent AF. Women were seen with greater QoL impairment at baseline, but the sex gap narrowed at 1-year follow-up. Conclusions In AF patients who underwent the combined procedure, women had similar procedural safety and long-term efficacy to men and presented greater QoL improvement. (Left Atrial Appendage Closure in Combination With Catheter Ablation [LAACablation]; NCT03788941).
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Key Words
- AF, atrial fibrillation
- AFEQT, Atrial Fibrillation Effect on Quality-of-Life questionnaire
- DRT, device-related thrombus
- LAA, left atrial appendage
- LAAC, left atrial appendage closure
- PDL, peridevice leak
- PVI, pulmonary vein isolation
- QoL, quality of life
- RFCA, radiofrequency catheter ablation
- SE, systemic embolism
- TEE, transesophageal echocardiography
- TIA, transient ischemic attack
- atrial fibrillation
- catheter ablation
- left atrial appendage closure
- quality of life
- sex differences
- stroke
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Affiliation(s)
- Mu Chen
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Jian Sun
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Wei Li
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Peng-Pai Zhang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Rui Zhang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Bin-Feng Mo
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Mei Yang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Qun-Shan Wang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yi-Gang Li
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
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Yoon CW, Bushnell CD. Stroke in Women: A Review Focused on Epidemiology, Risk Factors, and Outcomes. J Stroke 2023; 25:2-15. [PMID: 36746378 PMCID: PMC9911842 DOI: 10.5853/jos.2022.03468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
Stroke is a particularly important issue for women. Women account for over half of all persons who experienced a stroke. The lifetime risk of stroke is higher in women than in men. In addition, women have worse stroke outcomes than men. Several risk factors have a higher association with stroke in women than in men, and women-specific risk factors that men do not have should be considered. This focused review highlights recent findings in stroke epidemiology, risk factors, and outcomes in women.
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Affiliation(s)
- Cindy W. Yoon
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Cheryl D. Bushnell
- Department of Neurology, Wake Forest University School of Medicine, Winston Salem, NC, USA,Correspondence: Cheryl D. Bushnell Department of Neurology, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC 27157, USA Tel: +1-336-716-2983
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Han S, Jia R, Zhao S, Chan J, Bai Y, Cui K. Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies. Diagnostics (Basel) 2022; 12:diagnostics12123174. [PMID: 36553181 PMCID: PMC9777302 DOI: 10.3390/diagnostics12123174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Left atrial appendage closure (LAAC) is an established therapy for patients with atrial fibrillation (AF); however, there is a limited understanding of LAAC in elderly patients (≥75 years old). We conducted a meta-analysis to investigate the procedural complications and long-term outcomes after LAAC in the elderly versus the non-elderly. Methods: We screened PubMed, EMBASE, Cochrane Library, and Web of Science. Procedural endpoints of interest included successful implantation LAAC rates, in-hospital mortality, major bleeding events, pericardial effusion/tamponade, stroke, and vascular access complications related to LAAC. Long-term outcomes included all-cause mortality, major bleeding events, and stroke/transient ischemic attack (TIA) during follow-up. Results: Finally, 12 studies were included in the analysis; these included a total of 25,094 people in the elderly group and 36,035 people in the non-elderly group. The successful implantation LAAC rates did not differ between the groups, while the elderly patients experienced more periprocedural mortality (OR 2.62; 95% CI 1.79−3.83, p < 0.01; I2 = 0%), pericardial effusion/tamponade (OR 1.39; 95% CI: 1.06−1.82, p < 0.01; I2 = 0%), major bleeding events (OR 1.32; 95% CI 1.17−1.48, p < 0.01; I2 = 0%), and vascular access complications (OR 1.34; 95% CI 1.16−1.55, p < 0.01; I2 = 0%) than the non-elderly patients. The long-term stroke/TIA rates did not differ between the elderly and the non-elderly at least one year after follow-up. Conclusions: Even though successful implantation LAAC rates are similar, elderly patients have a significantly higher incidence of periprocedural mortality, major bleeding events, vascular access complications, and pericardial effusion/tamponade after LAAC than non-elderly patients. The stroke/TIA rates did not differ between both groups after at least one-year follow-up.
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31
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Alkhouli M, Ellis CR, Daniels M, Coylewright M, Nielsen-Kudsk JE, Holmes DR. Left Atrial Appendage Occlusion: Current Advances and Remaining Challenges. JACC. ADVANCES 2022; 1:100136. [PMID: 38939465 PMCID: PMC11198318 DOI: 10.1016/j.jacadv.2022.100136] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 06/29/2024]
Abstract
The field of left atrial appendage occlusion is rapidly evolving. However, several issues remain including the limited randomized efficacy data, peri-device leak, device-related thrombus, and the ongoing refinement of procedural techniques. In this article, we provide a contemporary overview of left atrial appendage occlusion focusing on 4 key remaining challenges: efficacy data, peri-device leak, device-related thrombus, and procedural optimization.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Christopher R. Ellis
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Matthew Daniels
- Institute of Cardiovascular Sciences, Core Technology Facility, University of Manchester, Manchester, United Kingdom
| | - Megan Coylewright
- Department of Cardiovascular Medicine, The Erlanger Heart and Lung Institute, Chattanooga, Tennessee, USA
| | | | - David R. Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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32
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Sandhu A, Varosy PD, Du C, Aleong RG, Tumolo AZ, West JJ, Tzou WS, Curtis JP, Freeman JV, Friedman DJ, Hess PL. Device-Sizing and Associated Complications With Left Atrial Appendage Occlusion: Findings From the NCDR LAAO Registry. Circ Cardiovasc Interv 2022; 15:e012183. [PMID: 36472194 DOI: 10.1161/circinterventions.122.012183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Left atrial appendage occlusion is an important alternative to anticoagulation in select patients with nonvalvular atrial fibrillation. Trends in real-world device sizing and associated short-term complications have not been characterized. METHODS Using the National Cardiovascular Data Left Atrial Appendage Occlusion (NCDR LAAO) Registry, patients who underwent left atrial appendage occlusion with a Watchman 2.5 device from January 1, 2016, to June 30, 2020, were identified. Patients were stratified by device size based on left atrial appendage orifice size, and categorized as receiving a device that was undersized, oversized, or per manufacturer recommendation. Relationships between device sizing and short-term outcomes, including pericardial effusion, device embolism, and significant leak, were assessed. RESULTS Of the 68 456 patients, 6539 (10.5%) of patients received undersized devices, 17 791 (26.0%) according to manufacturer recommendations, and 44 126 (64.4%) received an oversized device. The 27-mm device was most commonly deployed [21 736 (31.8%)], whereas the smallest and largest devices (21 and 33 mm) were least commonly deployed [7695 (11.2%) and 9077 (13.3%), respectively]. Compared with manufacturer recommended sizing, there was no difference in the odds of pericardial effusion for either undersized (1.048 [95% CI' 0.801-1.372]; P=0.733) or oversized (1.101 [95% CI' 0.933-1.298]; P=0.254) devices. Similarly, relative to manufacturer recommended sizing, the odds of a composite adverse outcome of device migration or embolization and significant peridevice leak at 45 days were similar among undersized devices (1.030 [95% CI' 0.735-1.444]; P=0.863) and favorable for oversized devices (0.701 [95% CI' 0.561-0.876]; P=0.002) devices, primarily driven by lower odds of leak. Selection of oversized devices increased significantly over the study period (from 60.3% in 2016 to 66.0% in 2020; P<0.001). CONCLUSIONS Among patients undergoing left atrial appendage occlusion with the first-generation Watchman device, receipt of oversized devices was common and increased over time. The high prevalence of oversizing was associated with lower odds of significant leak or device embolization without increased odds of other adverse events.
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Affiliation(s)
- Amneet Sandhu
- Section of Cardiology, Rocky Mountain Regional VA Medical Center, Aurora, CO (A.S., P.D.V., P.L.H.).,Section of Electrophysiology, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.S., P.D.V., R.G.A., A.Z.T., J.J.W., W.S.T.)
| | - Paul D Varosy
- Section of Cardiology, Rocky Mountain Regional VA Medical Center, Aurora, CO (A.S., P.D.V., P.L.H.).,Section of Electrophysiology, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.S., P.D.V., R.G.A., A.Z.T., J.J.W., W.S.T.)
| | - Chengan Du
- Section of Cardiovascular Medicine, Yale University School of Medicine' Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (C.D., J.P.C., J.V.F.)
| | - Ryan G Aleong
- Section of Electrophysiology, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.S., P.D.V., R.G.A., A.Z.T., J.J.W., W.S.T.)
| | - Alexis Z Tumolo
- Section of Electrophysiology, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.S., P.D.V., R.G.A., A.Z.T., J.J.W., W.S.T.)
| | - J Jason West
- Section of Electrophysiology, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.S., P.D.V., R.G.A., A.Z.T., J.J.W., W.S.T.)
| | - Wendy S Tzou
- Section of Electrophysiology, Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.S., P.D.V., R.G.A., A.Z.T., J.J.W., W.S.T.)
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine' Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (C.D., J.P.C., J.V.F.)
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine' Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (C.D., J.P.C., J.V.F.)
| | - Daniel J Friedman
- Section of Electrophysiology, Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F.)
| | - Paul L Hess
- Section of Cardiology, Rocky Mountain Regional VA Medical Center, Aurora, CO (A.S., P.D.V., P.L.H.).,Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (P.L.H.)
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Price MJ, Friedman DJ, Du C, Wang Y, Lin Z, Curtis JP, Freeman JV. Comparative Safety of Transcatheter LAAO With the First-Generation Watchman and Next-Generation Watchman FLX Devices. JACC Cardiovasc Interv 2022; 15:2115-2123. [DOI: 10.1016/j.jcin.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/09/2022]
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Kawamura I, Kuno T, Sahashi Y, Tanaka Y, Passman R, Briasoulis A, Malik AH. Thirty-day readmission rate of same-day discharge protocol after left atrial appendage occlusion: A propensity score-matched analysis from the National Readmission Database. Heart Rhythm 2022; 19:1819-1825. [PMID: 35835364 DOI: 10.1016/j.hrthm.2022.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 07/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Given the reduction in periprocedural complication rates, same-day discharge (SDD) after percutaneous left atrial appendage closure (LAAC) could be beneficial. To date, little data exist comparing the standard overnight stay (ONS) vs SDD after LAAC. OBJECTIVE The purpose of this study was to investigate the safety and efficacy of SDD compared with ONS. METHODS A retrospective cohort study of LAAC procedures performed in the United States from 2015 to 2019 was conducted using the US Nationwide Readmission Database. The primary outcome was all-cause 30-day readmission after discharge in patients who underwent LAAC, and a secondary outcome was requiring total health care cost. A 1:1 propensity score matching was conducted for adjustment. Multivariate Cox proportional hazards regression was also performed to estimate the hazard ratio for all-cause readmission within 30 days of LAAC. RESULTS Of 48,953 patients (mean age 76.0 ± 7.9 years), 972 patients (1.99%) were discharged on the same day after LAAC (SDD group) and the remaining 47,981 patients stayed at least 1 night (ONS group). A propensity score-matched analysis generated 961 matched pairs in each group. The 30-day readmission rate after discharge was similar between the groups (SDD vs ONS: 8.5% vs 9.8%; P = .31; hazard ratio 1.13; 95% confidence interval 0.78-1.63; P = .53). The total required health care cost was significantly lower in the SDD group ($23,720 [$18,075-$29,416] vs $25,877 [$19,906-$32,748]; P < .01). Gastrointestinal bleeding was the major cause for readmission (SDD vs ONS: 14.7% vs 15.1%; P = .95), but stroke and pericardial effusion were rare. CONCLUSION In patients without procedure-related complications, SDD is a safe and cost-effective protocol.
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Affiliation(s)
- Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Yuki Sahashi
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan; Department of Cardiology, Gifu University Graduate School of Medicine, Gifu, Japan; Department of Health Data Science, Graduate School of Data Science, Yokohama City University, Yokohama, Japan
| | - Yoshihiro Tanaka
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rod Passman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center, Valhalla, New York
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Nielsen-Kudsk JE. Left Atrial Appendage Occlusion. JACC Cardiovasc Interv 2022; 15:2156-2157. [DOI: 10.1016/j.jcin.2022.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/09/2022]
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36
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Kümler T, Strange JE, Andersen NH. Percutaneous left atrial appendage occlusion discrepancy between randomised trials and clinical practice. Open Heart 2022; 9:openhrt-2022-002079. [PMID: 36270714 PMCID: PMC9594568 DOI: 10.1136/openhrt-2022-002079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/05/2022] Open
Abstract
In patients with atrial fibrillation and previous episodes of bleeding on oral anticoagulant treatment, left atrial appendage occlusion (LAAO) has emerged as an alternative way to decrease the risk of stroke. The use of the procedure has been on the rise, and the news coverage has been dominated by an uncritical acceptance of the benefit of this procedure, which probably have contributed to the increasing number of procedures. This commentary is a presentation and critical appraisal of the available evidence on the efficacy and safety of left atrial appendage closure as stroke prophylaxis. We illustrate that LAAO is supported by limited randomised data risk of serious complications, which we do not believe supports the current widespread use.
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Atrial Fibrillation in Women: from Epidemiology to Treatment. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alkhouli M, Russo AM, Thaler D, Windecker S, Anderson JA, Gage R, Lakkireddy D. Sex Differences in Safety and Effectiveness of Left Atrial Appendage Occlusion. JACC Cardiovasc Interv 2022; 15:2143-2155. [DOI: 10.1016/j.jcin.2022.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022]
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Left atrial appendage occlusion should be offered only to select atrial fibrillation patients. Heart Rhythm O2 2022; 3:448-454. [PMID: 36097461 PMCID: PMC9463703 DOI: 10.1016/j.hroo.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 11/21/2022] Open
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40
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Zhu Y, Sasmita BR, Xue Y, Jiang Y, Huang B, Luo S. Sex differences on outcomes following left atrial appendage occlusion in atrial fibrillation: A systematic review and meta-analysis. Catheter Cardiovasc Interv 2022; 100:612-619. [PMID: 35801485 DOI: 10.1002/ccd.30323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/11/2022] [Accepted: 06/26/2022] [Indexed: 11/12/2022]
Abstract
There is a lack of sufficient data on sex-related differences in outcomes of nonvalvular atrial fibrillation (AF) patients following left atrial appendage occlusion (LAAO). We conducted a meta-analysis to investigate the procedural complications and long-term outcomes after LAAO in women versus men. We screened Medline, EMBASE, Cochrane Center Register of Controlled Trials, and Clinical Trials.gov. The inclusion criteria were studies targeting the sex-related differences in outcomes in nonvalvular AF patients treated by LAAO. Procedural endpoints of interest included success rate, pericardial complications, major bleeding, and vascular complications during hospitalization. Long-term outcomes included all-cause mortality and ischemic stroke during follow-up. Studies that merely considered sex in the subgroup analysis were not included. Six observational studies with a total of 64,035 patients were identified. The procedural success rates did not differ between sexes (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.89-1.09, p = 0.77), while women experienced more pericardial complications (OR: 1.78, 95% CI: 1.58-2.01, p < 0.00001), major bleedings (OR: 2.04, 95% CI: 1.75-2.39, p < 0.00001), and vascular complications (OR: 1.75, 95% CI: 1.41-2.17, p < 0.00001) than men. The sensitivity analysis performed by removing the largest study showed good stability. The long-term mortality and stroke rates did not differ between women and men in either the 1-year subgroup or the 2-year subgroup. In conclusion, despite comparable procedural success rates, women have a significantly higher incidence of pericardial complications, major bleeding, and vascular complications following LAAO. The long-term mortality and stroke rates do not differ between the sexes.
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Affiliation(s)
- Yuansong Zhu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bryan Richard Sasmita
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhou Xue
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Jiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bi Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Alkhouli M, Du C, Killu A, Simard T, Noseworthy PA, Friedman PA, Curtis JP, Freeman JV, Holmes DR. Clinical Impact of Residual Leaks Following Left Atrial Appendage Occlusion: Insights From the NCDR LAAO Registry. JACC Clin Electrophysiol 2022; 8:766-778. [PMID: 35387751 PMCID: PMC9233062 DOI: 10.1016/j.jacep.2022.03.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Data on the impact of residual peri-device leak after left atrial appendage occlusion (LAAO) are limited. OBJECTIVES The goal of this study was to explore the association of peri-device leak with adverse clinical events. METHODS The National Cardiovascular Data Registry LAAO Registry was queried to identify patients undergoing LAAO between January 1, 2016, and December 31, 2019. Patients were classified according to leak size on echocardiography at 45 ± 14 days (0 mm, no leak; >0-5 mm, small leak; and >5 mm, large leak). RESULTS A total of 51,333 patients were included, of whom 37,696 (73.4%) had no leak, 13,258 (25.8%) had small leaks, and 379 (0.7%) had large leaks. The proportion of patients on warfarin at 45 days was higher in the large vs small or no leak cohorts (44.9% vs 34.4% and 32.4%, respectively; P < 0.001). At 6 and 12 months, anticoagulant utilization decreased but remained more frequent in patients with large leaks. Thromboembolic and bleeding events were uncommon in all groups. However, compared with patients with no leak, those with small leaks had slightly higher odds of stroke/transient ischemic attack/systemic embolization (adjusted HR: 1.152; 95% CI: 1.025-1.294), major bleeding (HR: 1.11; 95% CI: 1.029-1.120), and any major adverse events (HR: 1.102; 95% CI: 1.048-1.160). There were no significant differences in adverse events between patients with large leaks and patients with small or no leaks. CONCLUSIONS Small (>0-5 mm) leaks after LAAO were associated with a modestly higher incidence of thromboembolic and bleeding events; large leaks (>5 mm) were not associated with adverse events, although higher proportions of these patients were maintained on anticoagulation. Newer devices with improved seal might mitigate the events associated with residual leaks.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Chengan Du
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ammar Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Shatla I, El-Zein RS, Kennedy K, Elkaryoni A, Ubaid A, Wimmer AP. Comparison of the Safety of Left Atrial Appendage Occlusion in Patients Aged <75 Versus Those Aged ≥75 Years (from a Nationwide Cohort Sample). Am J Cardiol 2022; 172:35-39. [PMID: 35317930 PMCID: PMC10041667 DOI: 10.1016/j.amjcard.2022.02.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
The mean age in clinical trials of percutaneous left atrial appendage occlusion (LAAO) has been <75 years. We aimed to better understand the safety of LAAO in older patients. National Inpatient Sample and International Classification of Diseases, Tenth Revision codes were used to identify patients with atrial fibrillation who underwent LAAO during the years 2016-2018. Patients were grouped by age <75 and ≥75 years. Baseline characteristics; length of stay; cost; hospital mortality; and other adverse events, including hematoma, vascular complications, perforation/tamponade, and stroke/ transient ischemic attack, were compared for the 2 groups. A total of 6,877 patients were identified, of whom 4,160 (60.4%) were aged ≥75 years. Length of stay and hospitalization costs were similar for the 2 groups. There were 10 deaths in patients aged ≥75 years and 1 death in patients aged <75 years (p = 0.059). The incidence of perforation/tamponade was 1.3% in patients aged ≥75 years versus 0.6% for those <75 years (p = 0.008). This difference persisted on multivariate analysis (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.01 to 3.07). The risk of perforation/tamponade was also higher in female patients (OR 2.74, 95% CI 1.63 to 4.59). There was a trend toward higher combined procedure-related adverse events (OR 1.46, 95% CI 0.99 to 2.15) in patients ≥75 years. There was no difference in the individual components of hematoma, vascular complication, and stroke/transient ischemic attack between both groups. In conclusion, percutaneous LAAO was associated with a higher risk of perforation and tamponade in older patients, particularly women.
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Affiliation(s)
- Islam Shatla
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Rayan S El-Zein
- Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kevin Kennedy
- Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Ahmed Elkaryoni
- Division of Cardiovascular Disease, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, Illinois
| | - Aamer Ubaid
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Alan P Wimmer
- Department of Internal Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; Division of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
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43
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Price MJ, Valderrábano M, Zimmerman S, Friedman DJ, Kar S, Curtis JP, Masoudi FA, Freeman JV. Periprocedural Pericardial Effusion Complicating Transcatheter Left Atrial Appendage Occlusion: A Report From the NCDR LAAO Registry. Circ Cardiovasc Interv 2022; 15:e011718. [PMID: 35369701 PMCID: PMC9132377 DOI: 10.1161/circinterventions.121.011718] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pericardial effusion (PE) is a potential complication of transcatheter left atrial appendage occlusion. The objective of this study was to investigate the incidence, associated characteristics, and outcomes of PE following left atrial appendage occlusion. METHODS Patients in the NCDR LAAO Registry who underwent a Watchman procedure between January 1, 2016 and December 31, 2019 were included. The primary outcome was in-hospital PE requiring intervention (percutaneous drainage or surgery). Odds ratios (ORs) were calculated for adverse event rates associated with PE. RESULTS The study population consisted of 65 355 patients. The mean patient age was 76.2±8.1 years, and the mean CHA2DS2-VASc score was 4.6±1.5. PE occurred in 881 patients (1.35%). Clinical variables independently associated with PE included older age, female sex, left ventricular function, paroxysmal atrial fibrillation, prior bleeding, lower serum albumin, and preprocedural dual antiplatelet therapy; procedural variables included number of delivery sheaths used, sinus rhythm during the procedure, and moderate sedation rather than general anesthesia. PE was associated with increased risk of in-hospital stroke (OR, 6.58 [95% CI, 3.32-13.06]; P<0.0001), death (OR, 56.88 [95% CI, 39.79-81.32]; P<0.0001), and the composite of death, stroke, or systemic embolism (OR, 28.64 [95% CI, 21.24-38.61]; P<0.0001). PE during the index hospitalization was associated with increased risk of death (OR, 3.52 [95% CI, 2.23-5.54]; P<0.0001) and the composite of death, stroke, or systemic embolism (OR, 3.42 [95% CI, 2.31-5.07]; P<0.0001) between discharge and 45-day follow-up. CONCLUSIONS In-hospital PE during transcatheter left atrial appendage occlusion is infrequent but associated with a substantially higher risk of adverse events, including in-hospital and early postdischarge mortality. Strategies to minimize PE are critical to improve the risk-benefit ratio for this therapy.
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Affiliation(s)
- Matthew J. Price
- Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California
| | - Miguel Valderrábano
- Division of Cardiac Electrophysiology, Houston Methodist Hospital, Houston, TX
| | - Sarah Zimmerman
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA
| | - Jeptha P. Curtis
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | | | - James V. Freeman
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
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Dhruva SS, Redberg RF. Letter by Dhruva and Redberg Regarding Article, "Amplatzer Amulet Left Atrial Appendage Occluder Versus Watchman Device for Stroke Prophylaxis (Amulet IDE): A Randomized, Controlled Trial". Circulation 2022; 145:e845-e846. [PMID: 35467950 DOI: 10.1161/circulationaha.121.057472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sanket S Dhruva
- Philip R. Lee Institute for Health Policy Studies (S.S.D., R.F.R.)
- University of California, San Francisco. Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (S.S.D.)
| | - Rita F Redberg
- Philip R. Lee Institute for Health Policy Studies (S.S.D., R.F.R.)
- Department of Medicine, Division of Cardiology (R.F.R.), University of California, San Francisco School of Medicine, San Francisco
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45
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Amuthan R, Curtis AB. Sex-Specific Considerations in Drug and Device Therapy of Cardiac Arrhythmias. J Am Coll Cardiol 2022; 79:1519-1529. [DOI: 10.1016/j.jacc.2021.11.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/05/2021] [Indexed: 12/28/2022]
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46
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Zeitler EP, Poole JE, Albert CM, Al-Khatib SM, Ali-Ahmed F, Birgersdotter-Green U, Cha YM, Chung MK, Curtis AB, Hurwitz JL, Lampert R, Sandhu RK, Shaik F, Sullivan E, Tamirisa KP, Santos Volgman A, Wright JM, Russo AM. Arrhythmias in Female Patients: Incidence, Presentation and Management. Circ Res 2022; 130:474-495. [PMID: 35175839 DOI: 10.1161/circresaha.121.319893] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a growing appreciation for differences in epidemiology, treatment, and outcomes of cardiovascular conditions by sex. Historically, cardiovascular clinical trials have under-represented females, but findings have nonetheless been applied to clinical care in a sex-agnostic manner. Thus, much of the collective knowledge about sex-specific cardiovascular outcomes result from post hoc and secondary analyses. In some cases, these investigations have revealed important sex-based differences with implications for optimizing care for female patients with arrhythmias. This review explores the available evidence related to cardiac arrhythmia care among females, with emphasis on areas in which important sex differences are known or suggested. Considerations related to improving female enrollment in clinical trials as a way to establish more robust clinical evidence for the treatment of females are discussed. Areas of remaining evidence gaps are provided, and recommendations for areas of future research and specific action items are suggested. The overarching goal is to improve appreciation for sex-based differences in cardiac arrhythmia care as 1 component of a comprehensive plan to optimize arrhythmia care for all patients.
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Affiliation(s)
- Emily P Zeitler
- The Geisel School of Medicine at Dartmouth, Hanover, NH (E.P.Z.).,Division of Cardiology, Dartmouth-Hitchcock Medical Center, The Dartmouth Institute, Lebanon, NH (E.P.Z.)
| | - Jeanne E Poole
- University of Washington Medical Center, Seattle (J.E.P.)
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA (C.M.A., R.K.S.)
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A.-K.)
| | | | | | - Yong-Mei Cha
- Mayo Clinic, St Mary's Campus, Rochester, MN (F.A.-A., Y.-M.C.)
| | | | - Anne B Curtis
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo General Medical Center, NY (A.B.C.)
| | | | - Rachel Lampert
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (R.L.)
| | - Roopinder K Sandhu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Hospital, Los Angeles, CA (C.M.A., R.K.S.)
| | - Fatima Shaik
- Division of Cardiology, Cooper Medical School of Rowan University, Camden, NJ (F.S., A.M.R.)
| | | | | | | | - Jennifer M Wright
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (J.M.W.)
| | - Andrea M Russo
- Division of Cardiology, Cooper Medical School of Rowan University, Camden, NJ (F.S., A.M.R.)
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47
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Ahuja T, Kiefer NJ, Manmadhan A. To Occlude or Not to Occlude the Left Atrial Appendage in Women. JAMA Cardiol 2022; 7:464. [PMID: 35171202 DOI: 10.1001/jamacardio.2021.5930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tania Ahuja
- Department of Pharmacy, NYU Langone Health, New York, New York
| | - Nicholas J Kiefer
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.,Bellevue Hospital, Bellevue, Ohio.,Manhattan VA Hospital, New York, New York
| | - Arun Manmadhan
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, New York.,Bellevue Hospital, Bellevue, Ohio.,Manhattan VA Hospital, New York, New York
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48
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Darden D, Freeman JV, Hsu JC. To Occlude or Not to Occlude the Left Atrial Appendage in Women-Reply. JAMA Cardiol 2022; 7:464-465. [PMID: 35171204 DOI: 10.1001/jamacardio.2021.5933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Douglas Darden
- Division of Cardiology, Department of Medicine, University of California, San Diego
| | - James V Freeman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jonathan C Hsu
- Division of Cardiology, Department of Medicine, University of California, San Diego
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49
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Patel N, Ranka S, Hajra A, Bandyopadhyay D, Amgai B, Chakraborty S, Khalid M, Goyal A, Dalia T, Reddy YM, Shani J. Gender-Specific Outcomes after Percutaneous Left Atrial Appendage Closure - A Nationwide Readmission Database Analysis. J Cardiovasc Electrophysiol 2022; 33:430-436. [PMID: 35023251 DOI: 10.1111/jce.15359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Thromboembolism-associated stroke is the most feared complication of Atrial fibrillation (AF). Percutaneous left atrial appendage closure (pLAAC) is indicated for stroke prevention in patients with AF who can't tolerate long-term anticoagulation. We aim to study gender differences in peri-procedural and readmissions outcomes in pLAAC patients. METHODS Using the national readmission database from January 2016 to December 2018, AF patients undergoing the pLAAC procedure were identified. We used multivariate logistic regression analyses and time-to-event Cox regression analyses to conduct the study. Propensity matching with the Greedy method was done for the accuracy of results. RESULT 28,819 patients were included in our study. Among them 11,946 (41.5%) were women and 16,873 (58.6%) were men. The mean age of overall population was 76.1 ± 8.5 years, with women ~ 1 year older than men. The overall rate of complications was higher in women (8.6% vs 6.6%, P<0.001), primarily driven by bleeding-related complications i.e., Major bleed (OR: 1.32 95% CI: 1.03-1.69, p=0.029), blood transfusion (OR: 1.45, 95% CI: 1.06-1.97, p=0.019) and cardiac tamponade (OR: 1.80, 95% CI: 1.13-2.89, p=0.014). Women had two times higher peri-procedural ischemic stroke. There was no difference in peri-procedural mortality. Women remained at 20% and 13% higher risk for readmission at 30 days and 6 months of discharge. CONCLUSION Women had higher peri-procedural complications and were at higher risk of readmissions at 30 days and six months. However, there was no difference in mortality during the index hospitalization. Further studies are necessary to determine causality. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Neel Patel
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Sagar Ranka
- University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | | | | - Amandeep Goyal
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Tarun Dalia
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Y Madhu Reddy
- University of Kansas Medical Center, Kansas City, KS, USA
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