Comorbidity burden in patients undergoing left atrial appendage closure

Objective To estimate the risk of in-hospital complications after left atrial appendage closure (LAAC) in relationship with comorbidity burden. Methods Cohort-based observational study using the US National Inpatient Sample database, 1 October 2015 to 31 December 2017. The main outcome of interest was the occurrence of in-hospital major adverse events (MAE) defined as the composite of bleeding complications, acute kidney injury, vascular complications, cardiac complications and postprocedural stroke. Comorbidity burden and thromboembolic risk were assessed by the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Score (ECS) and CHA2DS2-VASc score. MAE were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The associations of comorbidity with in-hospital MAE were evaluated using logistic regression models. Results A total of 3294 hospitalisations were identified, among these, the mean age was 75.7±8.2 years, 60% were male and 86% whites. The mean CHA2DS2-VASc score was 4.3±1.5 and 29.5% of the patients had previous stroke or transient ischaemic attack. The mean CCI and ECS were 2.2±1.9 and 9.7±5.8, respectively. The overall composite rate of in-hospital MAE after LAAC was 4.6%. Females and non-whites had about 1.5 higher odds of in-hospital AEs as well participants with higher CCI (adjusted OR (aOR): 1.19, 95% CI: 1.13 to 1.24, p<0.001), ECS (aOR: 1.06, 95% CI: 1.05 to 1.08, p<0.001) and CHA2DS2-VASc score (aOR: 1.08, 95% CI: 1.02 to 1.15, p=0.01) were significantly associated with in-hospital MAE. Conclusion In this large cohort of LAAC patients, the majority of them had significant comorbidity burden. In-hospital MAE occurred in 4.6% and female patients, non-whites and those with higher burden of comorbidities were at higher risk of in-hospital MAE after LAAC.

[1]  M. Savage,et al.  The predictive value of CHA2DS2-VASc score on in-hospital death and adverse periprocedural events among patients with the acute coronary syndrome and atrial fibrillation who undergo percutaneous coronary intervention: a 10-year National Inpatient Sample (NIS) analysis. , 2020, Cardiovascular revascularization medicine : including molecular interventions.

[2]  E. Michos,et al.  Relation of Frailty to Outcomes in Patients With Acute Coronary Syndromes. , 2019, The American journal of cardiology.

[3]  M. Walsh,et al.  Discharge against medical advice after hospitalisation for acute myocardial infarction , 2018, Heart.

[4]  B. Kiaii,et al.  Association of comorbid burden with clinical outcomes after transcatheter aortic valve implantation , 2018, Heart.

[5]  R. Kornowski,et al.  Usefulness of the CHA2DS2-VASc Score to Predict Outcome in Patients Who Underwent Transcatheter Aortic Valve Implantation. , 2018, The American journal of cardiology.

[6]  B. Bouma,et al.  Elixhauser Comorbidity Score Is the Best Risk Score in Predicting Survival After Mitraclip Implantation , 2018 .

[7]  J. Healey,et al.  Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation , 2018 .

[8]  Harlan M. Krumholz,et al.  Adherence to Methodological Standards in Research Using the National Inpatient Sample , 2017, JAMA.

[9]  A. Verma,et al.  Contemporary Atrial Fibrillation Management: A Comparison of the Current AHA/ACC/HRS, CCS, and ESC Guidelines. , 2017, The Canadian journal of cardiology.

[10]  P. Kirchhof,et al.  2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[11]  I. Buchan,et al.  Predicting mortality from change-over-time in the Charlson Comorbidity Index , 2016, Medicine.

[12]  P. Kirchhof,et al.  2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. , 2016, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[13]  B. Meier,et al.  Left atrial appendage occlusion for stroke prevention in atrial fibrillation: multicentre experience with the AMPLATZER Cardiac Plug. , 2016, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[14]  S. Kische,et al.  Implant success and safety of left atrial appendage closure with the WATCHMAN device: peri-procedural outcomes from the EWOLUTION registry , 2016, European heart journal.

[15]  S. Anderson,et al.  Does the CHA2DS2-Vasc score predict procedural and short-term outcomes in patients undergoing transcatheter aortic valve implantation? , 2015, Open Heart.

[16]  B. Iung,et al.  Long-term outcome after transcatheter aortic valve implantation , 2015, Heart.

[17]  W. O’Neill,et al.  Utilization and Adverse Outcomes of Percutaneous Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation in the United States: Influence of Hospital Volume , 2015, Circulation. Arrhythmia and electrophysiology.

[18]  S. Anderson,et al.  Does the CHA2DS2-Vasc score predict procedural and short-term outcomes in patients undergoing transcatheter aortic valve implantation? , 2015, Open Heart.

[19]  M. Ezekowitz,et al.  2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. , 2014, Circulation.

[20]  J. Healey,et al.  2014 focused update of the Canadian Cardiovascular Society Guidelines for the management of atrial fibrillation. , 2014, The Canadian journal of cardiology.

[21]  M. Price,et al.  Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. , 2014, Journal of the American College of Cardiology.

[22]  David Ring,et al.  The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery , 2014, Clinical orthopaedics and related research.

[23]  C. Murray,et al.  Worldwide Epidemiology of Atrial Fibrillation: A Global Burden of Disease 2010 Study , 2014, Circulation.

[24]  Thomas Lumley,et al.  Two-sample rank tests under complex sampling , 2013 .

[25]  L. Lien,et al.  Clinical utility of CHADS2 and CHA2DS2-VASc scoring systems for predicting postoperative atrial fibrillation after cardiac surgery. , 2013, The Journal of thoracic and cardiovascular surgery.

[26]  G. Lip,et al.  Identifying Patients at High Risk for Stroke Despite Anticoagulation: A Comparison of Contemporary Stroke Risk Stratification Schemes in an Anticoagulated Atrial Fibrillation Cohort , 2010, Stroke.

[27]  Gregory Y H Lip,et al.  Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. , 2010, Chest.

[28]  Maurice Buchbinder,et al.  Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial , 2009, The Lancet.

[29]  P. Austin,et al.  A Modification of the Elixhauser Comorbidity Measures Into a Point System for Hospital Death Using Administrative Data , 2009, Medical care.

[30]  C. Steiner,et al.  Comorbidity measures for use with administrative data. , 1998, Medical care.

[31]  J. Odell,et al.  Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. , 1996, The Annals of thoracic surgery.

[32]  N. Ammash,et al.  Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: A transesophageal echocardiographics tudy , 1995 .

[33]  N. Ammash,et al.  Left atrial appendage thrombus is not uncommon in patients with acute atrial fibrillation and a recent embolic event: a transesophageal echocardiographic study. , 1995, Journal of the American College of Cardiology.

[34]  B. Lewis,et al.  Identifying patients at high risk for restenosis after percutaneous transluminal coronary angioplasty for unstable angina pectoris. , 1989, The American journal of cardiology.

[35]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.