Elsevier

International Journal of Cardiology

Volume 343, 15 November 2021, Pages 21-26
International Journal of Cardiology

Assessment of independent clinical predictors of early readmission after percutaneous endoluminal left atrial appendage closure with the Watchman device using National Readmission Database

https://doi.org/10.1016/j.ijcard.2021.08.043Get rights and content

Highlights

  • This study uses NRD to assesses the outcomes after percutaneous left atrial appendage closure within 30 days.

  • Our analysis found that almost one in every ten patients was getting readmitted after the procedure within 30 days.

  • Chronic Kidney disease and Heart failure were associated with a higher rate of readmission after the procedure.

  • Gastrointestinal Bleeding was one of the primary causes for readmission; however, it was not associated with an increased readmission rate after the procedure.

  • Heart Failure, Cardiac Dysrhythmias, and infections were other significant causes of readmission after the procedure.

Abstract

Background

Percutaneous endoluminal left atrial appendage closure (pLAAC) procedure has been used to prevent strokes in patients who are not eligible for long-term prophylactic anticoagulation. Since its approval, multiple studies have looked at its efficacy with comparable outcomes to anticoagulation, the current standard of care.

Objectives

To assess the readmission rate and determine the factors associated with readmission after the endocardial pLAAC procedure using the Watchman device.

Methods

Data was obtained from the National Readmission Database (NRD), and we used SPSS software to determine statistically significant clinical predictors affecting readmission after implantation of the Watchman device at 30 days.

Results

The rate of readmission was found to be 9.2%. The true median cost of index hospitalization for the total population in the study was found to be [median (interquartile range = IQR), p] USD 24594 (USD 18883–31,041), whereas the true median cost of admission for those who were getting readmitted after 30 days was [median (IQR)] USD 7699 (USD 4955–14,243). Multivariate analysis of all clinically relevant predictors showed adjusted ratio for [adjusted odds ratio (OR), 95% confidence interval (95% CI), p-value] female genders (1.288, 1.104–1.503, p = 0.001), discharge to home health care (6.155, 1.509–25.096, p = 0.01), chronic kidney disease (CKD) (1.847,1.511–2.258, p < 0.001), chronic lung disease (1.419, 1.194–1.686, p < 0.001), heart failure (1.280, 1.040–1.574, p = 0.02), pericardial disorders (1.485, 1.011–2.179, p = 0.04), fluid and electrolyte disorders (1.456,1.050–2.018, p = 0.02) in those who were getting readmitted at 30-days compared to those who were not readmitted. The median length of stay for the index hospitalization was found to be one day, whereas the median length of stay at the 30-day readmission was reported to be [Median (IQR)] 4 days (2–6 days). Major cardiac reasons for readmission were heart failure, arrhythmias, and pericardial disorders.

Conclusion

Our study aims to assess 30-day outcomes in the US population after pLAAC using a Watchman device. Our analysis showed that one in ten patients were getting readmitted. In addition, chronic kidney disease, chronic obstructive pulmonary disease, heart failure, and pericardial disorders were associated with higher readmission rates. These findings will help us assess clinical correlations and predict which patients are more at risk of readmission after a Watchman procedure.

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.

References (21)

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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 Cardiology
    Citation 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.

  • Actual management costs of patients with non-valvular atrial fibrillation treated with percutaneous left atrial appendage closure or oral anticoagulation

    2022, International Journal of Cardiology
    Citation 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].

1

Co-first author; Contributed equally to all aspects of the research.

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