Racial And Ethnic Differences In Treatment And Outcomes Of Left Atrial Appendage Occlusion In Patients With Atrial Fibrillation

Introduction: Non-white patients have been reported to face barriers to left atrial appendage occlusion (LAAO). Hypothesis: We hypothesized that white vs. non-white patients would have disparate wait times for and post-procedural treatment course after LAAO. Methods: We identified consecutive patients undergoing LAAO (Watchman TM ) at our institution between November 2015 - March 2020. In white vs. non-white patients, we compared patient characteristics, indications for LAAO, procedural wait time from index event (IE) and cardiology encounter to LAAO procedure, complications, post-procedure anticoagulation regimen, and adherence to 45-day post-procedural transesophageal echocardiogram (TEE). Results: Of 109 consecutive patients receiving LAAO implants, 45% were white (n = 49). White patients were less likely to have prior cerebral vascular accident (14% vs. 43%, p=0.001), heart failure (18% vs. 48%, p=0.001), and end stage renal disease (0% vs. 20%, p<0.001). White patients also had lower CHADS2VASc and HAS-BLED scores (4 vs. 4.8, p=0.006 and 3.5 vs. 4.2, p<0.001, respectively). The majority of both white and non-white patients underwent LAAO due to prior gastrointestinal bleed (66% vs. 76%, p=0.9). Non-white patients were more likely to be in poverty (55% vs. 15% p<0.001). There was no difference in median time from IE or initial cardiology encounter to LAAO procedure in whites vs. non-whites (10.5 vs. 13.7 months, p=0.9 and 1.9 vs 1.8 months p=0.6, respectively), and there was no significant difference in procedural complications, all of which were non-fatal pericardial effusions (4% vs. 5%, p=0.33). After adjusting for CHADS2VASc score, whites may have been more likely to be discharged on oral anticoagulation vs. dual anti-platelet therapy (OR 2.4, 95%CI [0.94-6] p=0.07). Adherence to post-procedural TEE was similar between groups (92% vs 90%, p=0.7). Conclusions: Whites and non-whites had similar indications for LAAO, procedural wait time, risk of procedural complications, and adherence to post-procedural TEE, despite a higher burden of co-morbidities. White patients may be more likely to be discharged on oral anticoagulation.