Abstract
Background: Prior studies have shown that WATCHMAN device can be an alternative for anticoagulation in atrial fibrillation (AF) patients for stroke reduction. Its impact on healthcare utilization in AF population remains unknown. Methods: We queried the 2016-2017 National Readmission Database for all adult AF patients undergoing WATCHMAN procedure using ICD10 codes. All patients discharged alive from February to November were included (N = 13192), and their bleeding/thrombosis related admissions pre- and post-index procedure were recorded. Hierarchical longitudinal negative binomial regression was done to calculate incidence rate ratios (IRR) of admissions pre- and post-procedure with patient and hospital as level 2 and 3 variables, respectively. Person-time was included as an offset variable to account for variation in pre and post-procedure time contribution by each patient. A second model was created that included a blanking period of 2 months post-procedure to account for continued anticoagulation after the procedure. For this analysis, patients who received the procedure in October and November (N = 3265) and also patients who died within 2 months of the procedure (N = 49) were excluded. Results: For 13192 patients, the mean age was 77 years and 39% were female. Overall, we found a decrease of ~23% in all-cause readmissions after the procedure (IRR = 0.77; 95% CI = 0.74-0.81; p<0.001). A much greater decrease in thrombosis related admissions of ~69% (IRR = 0.31, p<0.001) and bleeding related admissions of 46% (IRR=0.54, p<0.001) were noted. When applying the 2-month blanking period after the index procedure, we observed an even greater decrease in all-cause readmissions of ~37% post-procedurally. Similarly, there was a decrease of ~75% and ~74% in thrombosis- and bleeding-related admissions respectively (Figure 1). Conclusions: AF patients undergoing WATCHMAN procedure have a significantly lower readmission rate, especially for thromboembolic/bleeding related readmissions. Thus, there is a trend towards decrease in healthcare utilization post-procedurally. Further studies are needed to confirm and evaluate the reasons for these findings.
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