GENDER DISPARITIES IN OUTCOMES OF LEFT ATRIAL APPENDAGE OCCLUSION DEVICE PLACEMENT

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is associated with profound morbidity & mortality, including a fivefold increase in stroke risk. Due to side effects & compliance issues associated with anticoagulation, left atrial appendage occlusion (LAAO) devices have emerged as an alternative approach. However, women have been underrepresented in both the PROTECT & PREVAIL trials, landmark trials supporting LAAO use. Objective We aim to compare gender disparities in outcomes of LAAO occlusive devices. Methods The national readmission database (2016-2020) was utilized to identify hospitalizations for LAAO placement. Cohorts were stratified by gender. A propensity score matching (PSM) model matched males & females. Pearson’s x2 test was applied to PSM-2 matched cohorts to compare outcomes. Results Among 89,552 hospitalizations for LAAO placement; 41.3% of procedures were performed in females. Females were found to have a lower prevalence of diabetes, hypertension, hyperlipidemia & chronic kidney disease [p<0.001]. After propensity matching (N=20,627), females were found to have higher adverse events, including mortality (0.23% vs 0.15%,aOR:1.49, p:0.041), sudden cardiac arrest (1.77% vs 1.37%,aOR:1.38, p: 0.001), pericardial complications (1.46% vs 0.86%,aOR:1.65, p<0.001), cardiac tamponade (0.94% vs 0.54%,aOR:1.75, p<0.001), post-procedural bleeding (0.69% vs 0.53%,aOR:1.09, p:0.032) & net adverse events (NAE) (4.73% vs 4.24%,aOR: 1.17, p<0.001). Females also had higher readmission rates at 30-day (9.42% vs 8.07%, p<0.001) & subsequently at 90-day & 180-day intervals (p<0.001). No difference was noted in resource utilization (LOS & cost of hospitalization) between males & females (p>0.05). Conclusion In hospitalizations for LAAO device placement, females tend to suffer higher mortality, adverse events & readmission rates as compared to males; although resource utilization is similar.