PO-701-01 NINE MONTH READMISSION RATES AND CLINICAL OUTCOMES OF ANTICOAGULATION VERSUS WATCHMAN DEVICE IN OCTOGENARIANS

Abstract

Atrial Fibrillation (AF), the most common arrhythmia in older adults, is fraught with an increased risk of stroke. Studies which have demonstrated non-inferiority of Left atrial appendage occlusion (LAAO) with a watchman device compared to oral anticoagulation for stroke risk reduction in AF did not include patients greater than 80 years of age, making it difficult to generalize these results to this population. This study compared nine month clinical outcomes in patients aged 80 and above who had LAAO with a watchman device to those who were only on oral anticoagulation for AF. This was a retrospective cohort study using samples from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project NRD. We included patients aged 80 and above admitted between January 2016 and December 2018 with a primary diagnosis of AF or atrial flutter who had undergone LAAO with a watchman device or were only on oral anticoagulation. Clinical outcomes were assessed at 9 months after index admission. Primary outcomes were all-cause readmissions, readmissions due to intracranial hemorrhage (ICH), stroke or TIA. Secondary outcomes were readmissions due to gastrointestinal (GI) bleeding, hematuria and need for RBC transfusions, colonoscopy or upper endoscopy. Analysis was done with STATA 17 (Stata Statistical Software: Release 17. College Station, TX: StataCorp LLC). Owing to differences in baseline characteristics, an adjusted analysis for the baseline characteristics was included. Our study consisted of a total of 491,329 patients in the anticoagulation group and 2030 patients in the watchman group. Baseline characteristics are depicted in table 1. At 9 month follow up, patients in the watchman group had a significantly higher frequency of all-cause readmissions compared to the anticoagulation group (8% vs 6%, P value 0.02, adjusted Odds Ratio 1.3, 95% CI 1.02 - 1.6). There were no significant differences in secondary outcomes between both groups as depicted in table 2. All-cause readmissions were significantly increased in the watchman group at 9 month follow-up despite no significant differences found in ICH, stroke and GI bleeding related readmissions between both groups. More studies are needed to support these findings.View Large Image Figure ViewerDownload Hi-res image Download (PPT)