Abstract 188: Ischemic Heart Disease Burden On Clinical Outcomes After Percutaneous Left Atrial Appendage Closure In Patients With Atrial Fibrillation In The United States

Abstract

Background: Percutaneous left atrial appendage closure (PLAAC) is an alternative to anticoagulants for atrial fibrillation patients with elevated stroke risk and contraindication to anticoagulation. We examined the burden of IHD on clinical outcomes after PLAAC. Methods: We identified patients from the Nationwide Readmission Database who underwent PLAAC with a Watchman device between 2014-2018 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the presence of IHD. Outcomes were all-cause and cause-specific 30-day readmissions and mortality rate during readmission. Multivariable regression was conducted for 30 days readmission adjusting for patient demographics,hospital characteristics, and Elixhauser Comorbidity Index. Results: A total of 18,348 Watchman recipients were identified, of which 8,504 had IHD while 9,844 had no ischemic heart disease (NIHD). Length of stay and cost were not different between groups. However, significant differences were noted in terms of the number of frequent index admission complications between the IHD vs. NIHD group, including transient ischemic attack/Stroke (3.5% Vs. 1.6%, P<0.0001) (Table 1). Although the 30 days readmission rate was higher in the IHD group (7.5% Vs. 6%, P=0.003), there was no difference in mortality. Most frequent causes of readmissions for IHD Vs. NIHD were Acute Kidney Injury (AKI) (26% Vs. 17.3%, P=0.009) and acute heart failure (HF) (24.1% Vs. 17%, P=0.015) (Table 1). In multivariate analysis, ICM PLAAC recipients had higher odds of 30-day readmission compared to NICM (OR=3.7, P=0.4). Renal failure patients have higher odds of 30-day readmission compared to non-renal failure ( OR=1.4, P=0.001). Conclusion: Thirty-day readmission rate in patients who underwent PLAAC was higher in the IHD group. However, no difference was noted in mortality between both groups. AKI and acute HF were significant causes of readmission in patients with IHD who underwent PLAAC. Further studies exploring these differences may help to prevent these readmissions.