Sex-Based Differences in Cardiovascular Outcomes Among Patients with
Atrial Fibrillation Undergoing Left Atrial Appendage Occlusion Device
Placement.
Abstract
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 were used as
our control group, while women comprised our cohort. The primary outcome
was inpatient mortality. Secondary outcomes included odds of mechanical
ventilation use, all cause 30-day readmission, cardiogenic shock,
pericardial complications, length of stay (LOS) and total
hospitalization charges (THC). Multivariate linear and logistic
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 inpatient mortality (adjusted OR [aOR] 1.92, 95% CI 1.04 –
3.5), cardiogenic shock (aOR 4.07, 95% CI 1.82 – 9.1), 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), pericardial complications
(aOR 2.5, 95% CI 1.83 – 3.3), longer LOS (1.34 vs 1.19 days,
p<0.001) and lower THC ($116,330 vs. $121,1870,
p<0.001) compared to male patients receiving a LAAOD.
Conclusion: Among patients with Atrial Fibrillation receiving a
LAAOD, a female sex was associated with higher odds of mortality,
non-fatal adverse events, and lower resource utilization compared to
male patients.