Racial disparities in the utilization and in-hospital outcomes of percutaneous left atrial appendage closure among patients with atrial fibrillation

Louis Vincent, Jelani Grant, Bertrand Ebner, Iordan Potchileev, Jennifer Maning, Odunayo Olorunfemi, Neal Olarte, Rosario Colombo, Eduardo de Marchena

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Select patients with atrial fibrillation and contraindication to anticoagulation may benefit from percutaneous left atrial appendage closure (pLAAC). Objective: The purpose of this study was to evaluate racial disparities in the nationwide utilization and outcomes of pLAAC. Methods: We identified 16,830 hospitalizations for pLAAC between 2015 and 2017 using the National Inpatient Sample. Baseline characteristics, in-hospital mortality, complications, length of stay, and discharge disposition were assessed between White and Black/African American (AA) populations. Results: Black/AA patients represented 4.1% of nationwide pLAAC recipients and were younger, more likely to be female, and had greater prevalence of hypertension, heart failure, hyperlipidemia, obesity, chronic kidney disease, and prior stroke history (P <.001 for all). Black/AA patients had significantly increased length of stay and nonroutine discharge (P <.001 for both) but comparable in-hospital mortality to White patients. Black/AA patients suffered from greater postoperative stroke (0.7% vs 0.2%), acute kidney injury (4.5% vs 2.1%), bleeding requiring transfusion (4.5% vs 1.4%), and venous thromboembolism (0.7% vs 0.1%; P <.01 for all). After controlling for possible confounding factors, Black/AA race was independently associated with significantly increased odds of bleeding requiring blood transfusion, stroke, venous thromboembolism, and nonroutine discharge. Conclusion: Among pLAAC recipients nationwide, Black/AA populations were underrepresented and had greater complication rates, length of stay, and discharge complexity. This study highlights the importance of addressing ongoing racial disparities in both utilization and outcomes of pLAAC.

Original languageEnglish (US)
Pages (from-to)987-994
Number of pages8
JournalHeart rhythm
Volume18
Issue number6
DOIs
StatePublished - Jun 2021
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Health equity
  • Percutaneous left atrial appendage closure
  • Population health
  • Racial disparity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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