Advertisement

Comparison of In-Hospital Outcomes After Insertion of Watchman Device in Men Versus Women (from the National Inpatient Data)

      Left atrial appendage occlusion with the Watchman device is approved to manage nonvalvular atrial fibrillation and prevent stroke in patients with contraindications to anticoagulation. This study aimed to analyze the National Inpatient Sample (NIS) data to evaluate gender disparities and further assess its impact on medical decision-making. The NIS data for 16,505 patients who underwent left atrial appendage occlusion with the Watchman device from 2016 to 2017 was used to perform a cross-sectional analysis. The primary end point was risk-adjusted in-hospital mortality. The study included 9,825 men and 6,680 women. Male patients were younger than female patients (mean age of 75.3 years vs 76.3 years, p <0.001). The observed in-hospital mortality was higher in female patients (0.3% vs 0.1%, p = 0.003). This remained significant after adjustment for baseline confounders (adjusted odds ratio 2.9, 95% confidence interval 1.4 to 6.3, p = 0.005). In conclusion, analysis of the large pool of NIS data reveals that female patients have relatively worse in-hospital outcomes in terms of mortality, length of stay, and total hospitalization cost than male patients who underwent Watchman device implantation. However, these disparities are not enough to impact the medical decision-making process and to defer the use of the Watchman device in female patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Benjamin EJ
        • Muntner P
        • Alonso A
        • Bittencourt MS
        • Callaway CW
        • Carson AP
        • Chamberlain AM
        • Chang AR
        • Cheng S
        • Das SR
        • Delling FN
        • Djousse L
        • Elkind MSV
        • Ferguson JF
        • Fornage M
        • Jordan LC
        • Khan SS
        • Kissela BM
        • Knutson KL
        • Kwan TW
        • Lackland DT
        • Lewis TT
        • Lichtman JH
        • Longenecker CT
        • Loop MS
        • Lutsey PL
        • Martin SS
        • Matsushita K
        • Moran AE
        • Mussolino ME
        • O'Flaherty M
        • Pandey A
        • Perak AM
        • Rosamond WD
        • Roth GA
        • Sampson UKA
        • Satou GM
        • Schroeder EB
        • Shah SH
        • Spartano NL
        • Stokes A
        • Tirschwell DL
        • Tsao CW
        • Turakhia MP
        • VanWagner LB
        • Wilkins JT
        • Wong SS
        • Virani SS
        American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2019 update: a report from the American Heart Association.
        Circulation. 2019; 139: e56-e528
        • Kabra R
        • Girotra S
        • Vaughan Sarrazin M
        Clinical outcomes of mortality, readmissions, and ischemic stroke among Medicare patients undergoing left atrial appendage closure via implanted device.
        JAMA Netw Open. 2019; 2e1914268
        • Oldgren J
        • Healey JS
        • Ezekowitz M
        • Commerford P
        • Avezum A
        • Pais P
        • Zhu J
        • Jansky P
        • Sigamani A
        • Morillo CA
        • Liu L
        • Damasceno A
        • Grinvalds A
        • Nakamya J
        • Reilly PA
        • Keltai K
        • Van Gelder IC
        • Yusufali AH
        • Watanabe E
        • Wallentin L
        • Connolly SJ
        • Yusuf S
        RE-LY Atrial Fibrillation Registry Investigators. Variations in cause and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: the RE-LY Atrial Fibrillation Registry.
        Circulation. 2014; 129: 1568-1576
        • Blackshear JL
        • Odell JA
        Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation.
        Ann Thorac Surg. 1996; 61: 755-759
        • Reddy VY
        • Doshi SK
        • Kar S
        • Gibson DN
        • Price MJ
        • Huber K
        • Horton RP
        • Buchbinder M
        • Neuzil P
        • Gordon NT
        • Holmes DR
        PREVAIL and PROTECT AF Investigators. 5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT-AF trials.
        J Am Coll Cardiol. 2017; 70: 2964-2975
        • Heckbert SR
        • Austin TR
        • Jensen PN
        • Chen LY
        • Post WS
        • Floyd JS
        • Soliman EZ
        • Kronmal RA
        • Psaty BM.
        Differences by race/ethnicity in the prevalence of clinically detected and monitor-detected atrial fibrillation: MESA.
        Circ Arrhythm Electrophysiol. 2020; 13e007698
        • Tamirisa KP
        • Al-Khatib SM
        • Mohanty S
        • Han JK
        • Natale A
        • Gupta D
        • Russo AM
        • Al-Ahmad A
        • Gillis AM
        • Thomas KL.
        Racial and ethnic differences in the management of atrial fibrillation.
        CJC Open. 2021; 3: S137-S148
        • Khan MZ
        • Munir MB
        • Darden D
        • Pasupula DK
        • Balla S
        • Han FT
        • Reeves R
        • Hsu JC.
        Racial disparities in in-hospital adverse events among patients with atrial fibrillation implanted with a Watchman left atrial appendage occlusion device: a US National perspective.
        Circ Arrhythm Electrophysiol. 2021; 14e009691
        • Zhao M
        • Post F
        • Muenzel M
        • Hou CR
        • Keil T
        • Yu J.
        Impact of sex differences on outcomes in patients with non-valvular atrial fibrillation undergoing left atrial appendage closure: a single-center experience.
        Int J Med Sci. 2021; 18: 1990-1998
        • Doshi R
        • Patel K
        • Decter D
        • Jauhar R
        • Meraj P.
        Gender disparities with the use of percutaneous left ventricular assist device in patients undergoing percutaneous coronary intervention complicated by cardiogenic shock: from pVAD Working Group.
        Indian Heart J. 2018; 70: S90-S95
        • Chen LY
        • Chung MK
        • Allen LA
        • Ezekowitz M
        • Furie KL
        • McCabe P
        • Noseworthy PA
        • Perez MV
        • Turakhia MP
        American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Stroke Council. Atrial fibrillation burden: moving beyond atrial fibrillation as a binary entity: a scientific statement from the American Heart Association.
        Circulation. 2018; 137: e623-e644
        • Proietti M
        • Boriani G.
        Obesity paradox in atrial fibrillation: implications for outcomes and relationship with oral anticoagulant drugs.
        Am J Cardiovasc Drugs. 2020; 20: 125-137
        • Rahman MU
        • Amritphale A
        • Kumar S
        • Trice C
        • Awan GM
        • Omar BA.
        Assessment of independent clinical predictors of early readmission after percutaneous endoluminal left atrial appendage closure with the Watchman device using National Readmission Database.
        Int J Cardiol. 2021; 343: 21-26
        • Cappola AR
        • Desai AS
        • Medici M
        • Cooper LS
        • Egan D
        • Sopko G
        • Fishman GI
        • Goldman S
        • Cooper DS
        • Mora S
        • Kudenchuk PJ
        • Hollenberg AN
        • McDonald CL
        • Ladenson PW
        • Celi FS
        • Dillman W
        • Ellervik C
        • Gerdes AM
        • Ho C
        • Iervasi G
        • Lerman A
        • Makino A
        • Ojamaa K
        • Peeters R
        • Pingitore A
        • Razvi S
        • Wassner AJ.
        Thyroid and cardiovascular disease: research agenda for enhancing knowledge, prevention, and treatment.
        Circulation. 2019; 139: 2892-2909
        • Lip GY
        • Nieuwlaat R
        • Pisters R
        • Lane DA
        • Crijns HJ.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.
        Chest. 2010; 137: 263-272
        • Kaw D
        • Malhotra D.
        Platelet dysfunction and end-stage renal disease.
        Semin Dial. 2006; 19: 317-322
        • Lane DA
        • Lip GY.
        Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation.
        Circulation. 2012; 126: 860-865
        • Ballard HS.
        The hematological complications of alcoholism.
        Alcohol Health Res World. 1997; 21: 42-52
        • Ogunsua AA
        • Shaikh AY
        • Ahmed M
        • McManus DD
        Atrial fibrillation and hypertension: mechanistic, epidemiologic, and treatment parallels.
        Methodist Debakey CardioVasc J. 2015; 11: 228-234