Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Cardiology, 6(11), 1275. https://doi.org/10.1001/jamacardio.2021.3021 Dr. Douglas Darden et al.
Points
- Left atrial appendage occlusion (LAAO) is an alternative treatment for atrial fibrillation, but women have been underrepresented in clinical trials, and sex-specific analyses are limited.
- A study evaluated 49,357 patients who underwent LAAO with the Watchman device, with 41.3% women and 58.7% men.
- Women had a higher prevalence of paroxysmal atrial fibrillation, prior stroke, and uncontrolled hypertension but a lower prevalence of congestive heart failure, diabetes, and coronary artery disease than men.
- After adjusting for confounding factors, women had a significantly higher likelihood of experiencing any adverse event and major adverse event compared to men, primarily due to pericardial effusion requiring drainage or significant bleeding.
- Women undergoing LAAO also had higher hospital stay rates longer than one day and a higher risk of death, emphasizing further research to develop risk reduction strategies, specifically addressing pericardial effusion and significant bleeding in women undergoing LAAO.
Summary
Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for select patients with atrial fibrillation. However, clinical trials of LAAO have underrepresented women and limited sex-specific subanalyses are available. This study evaluates sex differences in baseline characteristics and in-hospital outcomes of patients undergoing LAAO implantation.
The study included 49,357 National Cardiovascular Data Registry LAAO Registry patients who underwent LAAO with the Watchman device between January 2016 and June 2019. Among the patients, 41.3% were women, and 58.7% were men. The mean age of the cohort was 76.1 years. Women undergoing LAAO had a higher prevalence of paroxysmal atrial fibrillation, prior stroke, and uncontrolled hypertension than men. Conversely, women had a lower prevalence of congestive heart failure, diabetes, and coronary artery disease.
After adjusting for confounding factors, there were no significant differences between women and men in aborted or canceled procedures. However, women had a higher likelihood of experiencing any adverse event (6.3% vs. 3.9%) and significant adverse event (4.1% vs. 2.0%) than men. These adverse events were primarily related to pericardial effusion requiring drainage (1.2% vs. 0.5%) or major bleeding (1.7% vs. 0.8%). Women also had a higher rate of hospital stay longer than one day (16.0% vs. 11.6%) and a higher risk of death (adjusted odds ratio 2.01; 95% CI, 1.31-3.09) compared to men.
In conclusion, this study reveals that women undergoing LAAO have a significantly higher risk of in-hospital adverse events. The findings highlight the need for further research on risk reduction strategies, particularly addressing the risks of pericardial effusion and significant bleeding in women receiving LAAO. By better understanding these sex differences, targeted interventions can be developed to improve outcomes for women undergoing LAAO procedures.
Link to the article: https://jamanetwork.com/journals/jamacardiology/fullarticle/2782726
References Darden, D., Duong, T., Du, C., Munir, M. B., Han, F. T., Reeves, R., Saw, J., Zeitler, E. P., Al-Khatib, S. M., Russo, A. M., Minges, K. E., Curtis, J. P., Freeman, J. V., & Hsu, J. C. (2021). Sex differences in procedural outcomes among patients undergoing left atrial appendage occlusion: Insights from the ncdr laao registry. JAMA Cardiology, 6(11), 1275. https://doi.org/10.1001/jamacardio.2021.3021
