Utilization, Outcomes and Predictors of In-Hospital Mortality Associated with Percutaneous Left Atrial Appendage Closure

Background
Left atrial appendage (LAA) closure is an increasingly used alternative for stroke prevention in patients with atrial fibrillation. We sought to examine temporal trends in utilization, describe outcomes and identify predictors of in-hospital mortality in an all-comer population.

Methods
Study population was derived from the HCUP-NIS from 2008 to the third quarter of 2015. ICD-9 CM codes were used to identify patients undergoing LAA closure. Baseline patient characteristics and procedure outcomes were assessed. Multivariate analysis was used to adjust for baseline confounders.

Results
4,298 admissions for LAA closure were identified during the study period. A significant increase in the use of closure devices was observed from 6.5 cases per million hospitalizations in 2008 to 44.6 cases in 2015 (p<0.001) (Figure 1). Mean age of the recipients was 71.1 ± 12.5 years and 38.5% were female (Table 1). Overall in-hospital mortality was 2.2% (92 patients). Average length of stay was 5.8 ± 9.3 days. Pericardial complications occurred in 161 recipients (3.8%) (Table 2). After multivariate adjustment, independent predictors of mortality included dyslipidemia, peripheral vascular disease, CHF, thyroid disorders, coagulation disorders, acute kidney injury and prolonged hospitalization. (Table 3)

Conclusions
Utilization of LAA closure device has significantly increased in the US during the last eight years. Despite this increase, procedure complication rates remain low. In-hospital mortality is an infrequent complication of LAA closure. Multiple modifiable and non-modifiable factors are associated with a significant increase in mortality.