Sex disparities in outcomes of left atrial appendage occlusion

Abstract Background Atrial fibrillation (AF) is the most common arrhythmia in adults and is associated with an increased risk of embolic stroke. Left atrial appendage occlusion (LAAO), such as Watchman device, has demonstrated non-inferiority to anticoagulation in clinical trials for prevention of stroke in non-rheumatic AF. However, sex differences in outcomes of LAAO implantation have not been studied using a large real-world database. Purpose To identify the sex disparities in outcomes of LAAO Methods Data from the 2016-2020 National Inpatient Sample (NIS) were used to identify patients of ages ≥18 with a primary diagnosis of atrial fibrillation/flutter and a primary/secondary procedure code for LAAO. Various patient characteristics, comorbidities, and complications were also identified and compared. Propensity-matched cohorts were extracted after adjusting for multiple comorbidities and demographics. Results A total of 87,790 procedures of LAAO were performed between 2016-2020, with 58.4% males and 41.6% females. Whilst a yearly rise in the number of procedures was also observed, the trend was not statistically significant (ptrend=0.318) (Figure 1). Post-matching 6,842 males and 7,303 females were retained in our study. Females had a higher mean CHA2DS2-VASc score (4.6 vs.3.7, p<0.01) and longer length of stay than males (1.38 vs. 1.24 days, p<0.01). Furthermore, a higher incidence of cardiac tamponade (1.1% vs. 0.3%, p<0.01, aOR 3.642, 95% CI 2.231-5.946), need for mechanical ventilation (0.7% vs. 0.3%, p<0.01, aOR 1.994, 95% CI 1.168-3.401), and pericardial effusion (3.9% vs. 2.8%, p<0.01, aOR 1.359, 95% CI 1.124-1.643) were noted amongst females vs. males. Though post-procedure, females reported a higher incidence of acute kidney injury (2.2% vs. 1.9%, aOR 1.175, 95% CI 0.918-1.504, p=0.199), intra/post-operative haemorrhage (0.6% vs. 0.4%, aOR 1.635, 95% CI 0.981-2.726), and device failure (0.7% vs. 0.5%, aOR 1.118, 95% CI 0.692-1.806, p=0.650), this was not statistically significant. In addition, no differences were observed in the mean modified HAS-BLED score between the two groups (1.9 vs. 1.9, p=0.398) (Table 1). Conclusions By using a large propensity matched cohort of patients who have undergone LAAO procedure for AF, this study has demonstrated that length of stay, pericardial effusion, cardiac tamponade and need for mechanical ventilation are higher in females as compared to males. These findings necessitate the development of strategies to reduce the increased risk of adverse events for females.Figure 1