Patients with heart failure with reduced ejection fraction (HFrEF) were excluded from the major randomized trials evaluating percutaneous left atrial appendage closure (LAAC), and therefore available evidence regarding the outcomes of this procedure in this population remains limited. The aim of this study was to assess in-hospital events and 6-month readmissions after LAAC in patients with and without HFrEF using data from the United States Nationwide Readmissions Database between 2016 and 2020.
The primary endpoint was the incidence of major in-hospital adverse events, defined as death, stroke, pericardial effusion, cardiac tamponade, pericardial window, or blood transfusion. Secondary endpoints included 6-month readmissions for any cause, heart failure, or death/stroke.
A total of 50,526 LAAC procedures were identified, of which 5,895 patients (11.7%) had HFrEF. Mean age was 75.7 years and the average CHA₂DS₂-VASc score was 3.8. Patients with HFrEF had a higher burden of cardiovascular comorbidities, including coronary artery disease (70.7% vs. 45.5%), chronic kidney disease (40.8% vs. 22.2%), and diabetes mellitus (42.5% vs. 34.0%).
The rate of major in-hospital adverse events was higher among patients with HFrEF (6.0% vs. 5.0%; adjusted OR 1.23; 95% CI: 1.09-1.40; p=0.001). In addition, this group showed higher in-hospital mortality (0.4% vs. 0.2%; adjusted OR 2.42; 95% CI: 1.51-3.87; p=0.002) and a greater need for transfusion (2.6% vs. 1.7%; adjusted OR 1.32; 95% CI: 1.09-1.61; p=0.01). No significant differences were observed in the incidence of stroke, pericardial effusion, or cardiac tamponade.
At 6-month follow-up (n=21,606), the presence of HFrEF was associated with a higher risk of all-cause hospital 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 for death or stroke (adjusted HR 1.27; 95% CI: 1.03-1.57; p=0.001).
Left Atrial Appendage Closure in HFrEF: Higher Risk of Complications and Readmissions
In conclusion, approximately one in nine patients undergoing left atrial appendage closure has HFrEF. Although the procedure maintains an acceptable safety profile, these patients have a higher risk of in-hospital complications and readmissions during the first 6 months of follow-up, making them a high-risk population that requires more careful selection and closer follow-up.
Título Original: Outcomes of Left Atrial Appendage Occlusion in Heart Failure With Reduced Ejection Fraction.
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