Comparative Outcomes of Left Atrial Appendage Occlusion Device Implantation in Atrial Fibrillation Patients With Lower Stroke Risk

ABSTRACT Background Current guidelines recommend oral anticoagulation in atrial fibrillation (AF) patients with a CHA 2 DS 2 ‐VASc score ≥2 for stroke prevention. However, Centers for Medicare & Medicaid Services (CMS) reimburses left atrial appendage occlusion (LAAO) for patients with CHA 2 DS 2 ‐VASc score ≥3. This study aimed to evaluate differences in outcomes and complications of LAAO therapy in AF patients with a CHA 2 DS 2 ‐VASc score of ≥ 3 versus < 3. Methods National Inpatient Sample (NIS) and International Classification of Diseases, Tenth Revision codes were used to identify LAAO device implantation in the U.S. from years 2016 to 2020. The study population was stratified by stroke risk into two groups, CHA 2 DS 2 ‐VASc ≥ 3 and < 3. Study endpoints assessed included procedural complications, inpatient outcomes and resource utilization. Results A total of 73,795 and 15,500 LAAO devices were implanted in patients with CHA 2 DS 2 ‐VASc ≥ 3 and < 3, respectively. Compared to patients with CHA 2 DS 2 ‐VASc score of ≥ 3, patients with CHA 2 DS 2 ‐VASc < 3 had lower overall (6.9% vs 9.9%, P < 0.01) and major (4.5% vs 6.2%, P < 0.01) complications in the crude analysis. After multivariable adjustment for potential confounders, CHA 2 DS 2 ‐VASc < 3 was associated with lower overall complications (aOR 0.84, 95% CI 0.78 – 0.91), major complications (aOR 0.90, 95% CI 0.81–0.99) and cost of hospitalization (aOR 0.95, 95% CI 0.91–0.99). Conclusions Patients with CHA 2 DS 2 ‐VASc < 3 had lower complications and hospitalization costs after LAAO device implantation. These data, if redemonstrated in a large randomized trial, can have important clinical implications for stroke prevention in AF patients.