Assessment of independent clinical predictors of early readmission after percutaneous endoluminal left atrial appendage closure with the Watchman device using National Readmission Database
Introduction
Atrial fibrillation (AF) is the most common persistent arrhythmia, affecting 3 to 6 million people in the United States alone [1]. Anticoagulation is the cornerstone of stroke prevention in patients with AF [2]. However, several factors can prevent the use of oral anticoagulation in patients with AF [2]. The Watchman device is an FDA-approved alternative to anticoagulation for stroke prevention in patients with atrial fibrillation for whom chronic anticoagulation is contraindicated or deemed high risk. There have been favorable long-term outcomes in several studies analyzing the Watchman device for stroke prevention in these patients [3].
There are two procedural approaches in use for left atrial appendage closure. The epicardial method, which employs the Lariat device manufactured by SentreHEART, Inc.®, and the endocardial approach using the Watchman devices manufactured by Boston Scientific, Corp®, are currently in clinical practice for left atrial appendage closure [4]. As interventional cardiologists have become more accustomed to the endoluminal approach, the Watchman device has gained popularity for left atrial appendage closure.
Patients who undergo these procedures are usually elderly with multiple comorbidities that adversely affect the hospital readmission rate [5]. Therefore, we conducted this study to assess the readmission rate, cost of readmission, independent predictors, and significant comorbidities associated with readmission at 30-days after implantation of the Watchman device.
Section snippets
Study population
We conducted this study using the data from the NRD. The NRD is a representative sample containing national all-age, all-payer discharges from US nonfederal hospitals, from the Agency of Healthcare Research and Quality. This data represents about 18 million discharges (total weighted discharges of about 36 million) from 2017 across 28 geographically dispersed states in the US. This represents about 60% of the US population and 58.2% of US hospitalization used in our study. Our study was given
Results
Based on our inclusion and exclusion criteria, we identified a total of 8992 patients who underwent implantation of the Watchman device, as shown in Fig. 1. Of these patients, 829 (9.2%) patients were readmitted at 30-days. Table 1 exhibits the baseline characteristics of the population. The median age of patients was [Median (IQR), p] [77 years (71–82), p = 0.06]. Females constituted 46.9% of the patients who were getting readmitted. Medicare was the primary payer for (89.8%) most of these
Discussion
We conducted this study using the National Readmission Database data to look at the readmission rate at 30-days after pLAAC. The readmission rate was found to be 9.2%, which is slightly higher than rates observed in some previous studies (Vudanda et al. reported 8.3%), (Malik et al. reported 8.2%), (Sagar et al. reported 8.3%), (Lingling et al. reported 7.3%) [4], [7], [8], [9] but was less than readmission rates observed in other studies (Kabra et al. observed 9.3% and Mohammed et al. observed
Study limitations
NRD does not allow us to determine the regional variations within the dataset or out-of-state admissions. NRD also does not provide information on specific baseline data, including different racial populations or geographical distribution. The database does not link patient data over consecutive years. This study represents only hospital in-patient admissions and does not capture data of patients admitted as an outpatient/observation status. As with any observational data, the results do not
Declaration of Competing Interest
None.
Acknowledgment
We want to acknowledge the contribution of all the authors, the department of internal medicine, and the department of cardiology at the University of South Alabama University for their support.
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Cited by (6)
Comparison of In-Hospital Outcomes After Insertion of Watchman Device in Men Versus Women (from the National Inpatient Data)
2022, American Journal of CardiologyCitation Excerpt :A higher prevalence of obesity in female patients could point toward its negative impact on outcomes of the Watchman device, but further research would be warranted to establish a direct causal relation. A recent study indicated that chronic lung disease was associated with a higher readmission risk at 30 days after the Watchman device procedure.13 Higher incidence of chronic lung diseases in female patients in our study, along with the higher observed mortality, additionally points toward this association.
Percutaneous left atrial appendage closure vs oral anticoagulation: The scariest might be the cheepest
2022, International Journal of CardiologyActual management costs of patients with non-valvular atrial fibrillation treated with percutaneous left atrial appendage closure or oral anticoagulation
2022, International Journal of CardiologyCitation Excerpt :Rahman et al. [13,14] have investigated 30-day rehospitalization after percutaneous LAAC and identified additional costs for rehospitalization. They have reported an actual median cost for LAAC hospitalization of USD 24594 [13], much higher than our reported value of € 9601. With a 10% 30-day readmission rate, the actual median extra cost for a readmitted patient was USD 7699 [13].
Rehospitalization and actual management costs after percutaneous left atrial appendage closure: Facing the conundrum
2021, International Journal of CardiologyAll-cause unplanned readmissions in the United States: insights from the Nationwide Readmission Database
2023, Internal Medicine JournalPrediction of unplanned 30-day readmission for ICU patients with heart failure
2022, BMC Medical Informatics and Decision Making
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Co-first author; Contributed equally to all aspects of the research.