Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Bagur, Rodrigo

2nd Supervisor

Choi, Yun-Hee

Co-Supervisor

Abstract

Left atrial appendage closure (LAAC) is a non-pharmacologic approach for stroke prevention in patients with atrial fibrillation. The impact of comorbidity burden on adverse outcomes following LAAC is very important for clinical decision making. Cohort-based observational study was conducted to evaluate the association of comorbidity burden with in-hospital complications. Of 3294 participants (mean age was 75.7±8.2 years), 60% were male and 86% whites. The majority of participants undergoing LAAC presented with a significant number of comorbid conditions. The occurrence of in-hospital major adverse events (MAE) was 4.6%. Women and patients exhibiting higher Charlson Comorbidity Index (adjusted odds ratio [aOR]: 1.14, 95% confidence interval [CI]: 1.05-1.23, P=0.001), Elixhauser Comorbidity Score (aOR: 1.04, 95% CI: 1.02-1.07, P=0.002) and CHA2DS2-VASc (aOR: 1.11, 95% CI: 1.00-1.24, P=0.05) scores were associated with increased risk of in-hospital MAE after LAAC. Preprocedural comorbidity assessment is of paramount importance for risk stratification and further management of patients undergoing LAAC.

Summary for Lay Audience

Atrial fibrillation (AF) is an irregular heartbeat and can lead to fatal consequences like blood clots to the brain causing stroke and other heart-related complications such as heart failure. It is an increasingly common disease in the general population and is estimated to affect approximately 33.5 million people worldwide. Similarly, having multiple chronic diseases is becoming more common as the elderly population increases. The left atrial appendage (LAA) is a very small cavity of the heart placed in the upper left cavity of the heart (the left atrium). Convincing evidence shows that the LAA is the major source of blood clots and more than 90% of strokes originate in the LAA. Left atrial appendage closure (LAAC) is a nonpharmacologic procedure which closes off the opening of LAA in order to prevent blood clotting (stroke) in patients with AF. Validated chronic diseases scoring systems permit the estimation of worse outcomes in a wide spectrum of patients.

Cohort-based observational study was conducted to evaluate the association of comorbidity burden with in-hospital adverse outcomes. The results of this study including 3294 patients with AF who underwent LAAC showed that the majority of participants presented with a significant number of comorbid conditions, with more than half of the patients had ≥10 comorbidities. The occurrence of in-hospital major adverse events (MAE), including major bleeding, cardiovascular complications, vascular complications, cerebrovascular accident and acute kidney injury was 4.6%. Women and patients exhibiting a higher Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Score (ECS) and CHA2DS2-VASc scores were independently associated with increased risk of in-hospital MAE after LAAC.

Our analysis also adds new data regarding the decrease in overall in-hospital MAE as compared to previous pre-FDA approval observational data. Moreover, we found that the pre-procedural CCI, ECS, CHA2DS2-VASc scores were associated with in-hospital MAE following LAAC.

Pre-procedural chronic diseases assessment can be an essential tool in the area of cardiology for risk stratification and further management of patients undergoing LAAC. The results of this study can be used to inform health policy makers of the potential risks of multiple chronic diseases in patients undergoing LAAC.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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