RACIAL DISPARITIES IN THE UTILIZATION AND IN-HOSPITAL OUTCOMES OF PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE AMONG PATIENTS WITH ATRIAL FIBRILLATION: PERSPECTIVES FROM THE NATIONAL INPATIENT SAMPLE

Abstract

Background Select patients with atrial fibrillation and contraindication to anticoagulation may benefit from percutaneous left atrial appendage closure (pLAAC). However, studies remain limited regarding racial disparities in both utilization and outcomes of pLAAC. Methods We identified 16,830 hospitalizations for pLAAC between 2015-2017 using the National Inpatient Sample, with ICD-10 code ‘02L73DK.’ Patients of Asian, Native American and Other races were excluded (n = 750) along with patients of Hispanic ethnicity (n = 920) due to possible confounding from unidentifiable race. Baseline characteristics, in-hospital outcomes and discharge disposition were assessed between White and Black patients. Categorical variables were compared using the Pearson Chi-Squared test and continuous variables using independent samples t-testing. Results Among 16,830 patients, 14,435 (85.9%) identified as White and 685 (4.2%) as Black. Black patients were younger (70.1 ± 10.5 vs. 76.0 ± 7.8 years, p < 0.001), more likely to be female (50.4% vs 39.5%, p < 0.001) and had greater prevalence of hypertension, heart failure, hyperlipidemia, obesity, chronic kidney disease and prior stroke history (all p < 0.001). Black patients also more frequently met procedural eligibility with CHADSVASC Score ≥2 (96.3% vs. 94.4%, p = 0.04). All-cause mortality was comparable among Black and White patients (0.0% vs. 0.2%, p = 0.23). Compared to White patients, Black patients had longer average hospitalization time (2.12 ± 3.51 vs. 1.39 ± 1.50 days, p < 0.001), less frequent routine discharge (88.1% vs. 92.5%) and higher incidences of post-operative stroke (0.7% vs. 0.2%), bleeding requiring transfusion (4.5% vs. 1.4%), acute kidney injury (4.5% vs. 2.1%) and venous thromboembolism (0.7% vs. 0.1%, all p < 0.001). No major differences were noted in post-procedural shock or pericardial complications. Conclusion Among pLAAC recipients nationwide, Black patients were underrepresented and had higher complication rates, greater length of stay, and discharge complexity compared to White patients. This highlights the importance of addressing racial disparities in both candidate selection and in-hospital outcomes.