Outcomes of Left Atrial Appendage Occlusion in Heart Failure With Reduced Ejection Fraction

Résumé fourni par la source

BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) were excluded from major trials of left atrial appendage occlusion (LAAO). AIM: The objective of this study was to describe this population and evaluate outcomes after LAAO in patients with and without HFrEF. METHODS: Patients with and without HFrEF undergoing LAAO were identified in the Nationwide Readmissions Database from 2016 to 2020. Outcomes of interest were major in-hospital adverse events (death, stroke, pericardial effusion, tamponade, pericardial window, transfusion) and 6-month readmissions (any readmission, heart failure readmission, death/stroke readmission). To account for differences between patients with and without HFrEF, outcomes were evaluated using risk-adjusted logistic regression models and risk-adjusted Cox proportional hazards models. RESULTS: -VASC score was 3.8 ± 1.3 in the HFrEF group and 3.7 ± 1.4 in those without HFrEF. HFrEF was associated with a higher risk of composite in-hospital major adverse events (6.0% vs. 5.0%, adjusted OR 1.23 [95% CI 1.09-1.40], p = 0.001) and a higher risk of 6-month all-cause readmission (adjusted HR 1.18 [95% CI 1.08-1.28], p < 0.001), heart failure readmission (adjusted HR 1.59 [95% CI 1.46-1.72], p < 0.001), and readmission with death or stroke (adjusted HR 1.27 [95% CI 1.03-1.57], p = 0.001). CONCLUSION: One out of nine patients treated with LAAO in the United States has HFrEF, which is associated with a higher risk of major in-hospital complications and hospital readmission.

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