Abstract 14581: Impact of Heart Failure on 30-day Readmissions After Transcatheter Left Atrial Appendage Occlusion With the Watchman Device

Background: The Watchman device reduces the risk of stroke in select patients with atrial fibrillation (AF). AF commonly coexists with heart failure (HF) and these conditions harbor interrelated pathophysiological mechanisms and treatment strategies., the impact of comorbid heart failure on outcomes in patients with AF undergoing Watchman device implantation remains unclear.

Methods: We identified patients from the Nationwide Readmission Database who underwent Watchman device placement between 2014-2018 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the presence of HF. Outcomes were all-cause and cause-specific 30-day readmissions and mortality rate during readmission. Kaplan-Meier analysis was used to assess the association of HF with 30-day hospital readmission.

Results: We identified 18,349 recipients, 13,180 had no heart failure (NHF) while 5169 had HF. Mean age was similar between both groups. A total of 789 (5.9%) were readmitted within 30 days in the NHF compared to 439 (8.5%) in the non HF (NHF) group, The 30-day readmission rate was higher and Length of the stay was slightly longer in HF group. Prior stroke was more prevalent in the NHF group. Coronary artery disease, smoking, prior ICD, and obesity were more prevalent among HF group as demonstrated in table 1. The most common causes of readmissions for NHF vs HF were (acute heart failure: 15 vs 30%, p<0.001), (GI bleed: 19 vs 23%, P=0.16), and (AKI: 19 vs 27%, P<0.002). No difference in mortality or time-to readmission observed between both groups (Fig.1).

Conclusion: In this analysis, post-Watchman 30-day readmission frequency was higher in patients with HF compared with NHF, though the time-to readmission was similar. Interestingly, 1 in 7 patients with NHF at baseline was readmitted with acute HF. Additional studies are now needed to identify which triggers are responsible for these readmissions so that effective preventive efforts can be instituted to reduce these readmissions.

Real-world opportunity of empagliflozin to improve blood pressure control in African American patients with type 2 diabetes: A National Cardiovascular Data Registry "research-to-practice" project from the diabetes collaborative registry

The 1245.29 Trial recently showed that empaglifozin improved both blood pressure and glucose control in African American (AA) patients with type 2 diabetes (T2D) and hypertension. Using the Diabetes Collaborative Registry, a large-scale US registry of outpatients with diabetes recruited from primary care, cardiology and endocrinology practices, we sought to understand the potential impact of these observations in routine clinical practice. Among 74 290 AA patients with T2D from 368 US clinics, 60.4% had hypertension, of whom 34.5% had systolic blood pressure ≥ 140 mm Hg (20.8% of the total AA T2D population). Only 1.7% of this eligible population had been prescribed a sodium-glucose co-transporter two inhibitor. The mean estimated 5-year risk of cardiovascular death was 7.7%, which could be reduced to 6.2% when modelling the antihypertensive effect of empagliflozin across the eligible population (based on an 8-mm Hg blood pressure reduction). These findings may represent a potential opportunity for better management of cardiovascular risk factors and improved outcomes in this vulnerable cohort.