Sex-based differences in cardiovascular outcomes among patients with atrial fibrillation undergoing left atrial appendage occlusion device placement.

BACKGROUND

There is a growing body of data to support the presence of sex disparities in outcomes of cardiovascular related hospitalizations. Despite this, there remains a paucity of data on relationships between sex and in-hospital outcomes in patients receiving a left atrial appendage occlusion device (LAAOD).

METHODS

We examined the 2016-2020 Nationwide Readmission Database to identify patients with Atrial Fibrillation receiving a LAAOD. Men compromised the control group, while women comprised the cohort. The primary outcome was mortality. Secondary outcomes included odds of mechanical ventilation use, all cause 30 and 90 day readmission, pericardial complications, vascular complications requiring surgery and length of stay (LOS). Multivariate regression models were used to adjust for confounders.

RESULTS

Among the patients with Atrial fibrillation receiving LAAOD (N = 59,655), 43 % were Female. A Female sex was associated with higher odds of mortality (adjusted OR [aOR] 1.92, 95 % CI 1.04-3.5), mechanical ventilation use (aOR 2.02, 95 % CI 1.4-2.9), all cause 30-day readmission (aOR 1.33, 95 % CI 1.22-1.45), all cause 90-day readmissions (aOR 1.31, 95 % CI 1.2-1.43), pericardial complications (aOR 2.5, 95 % CI 1.83-3.3), and longer LOS (1.34 vs 1.19 days, p < 0.001) compared to male patients. No differences were observed regarding vascular complications requiring surgery between both groups.

CONCLUSIONS

The LAAOD procedure is a highly safe and effective intervention for patients with atrial fibrillation. However, a small subset of patients experiences fatal and non-fatal adverse outcomes, with women disproportionately affected. Further studies are needed to confirm these findings.