Women may have a significantly higher risk of in-hospital adverse events following left atrial appendage occlusion (LAAO), according to a study published Aug. 11 in JAMA Cardiology.

Douglas Darden, MD, et al., used data from ACC’s LAAO Registry to look at sex differences in baseline characteristics among patients undergoing LAAO with the WATCHMAN device and in-hospital outcomes. The study’s primary outcomes were aborted or canceled procedure, major adverse event, any adverse event, a hospital stay longer than one day and death.

The study cohort consisted of 49,357 patients with an average age of 76.1 years, 20,388 (41.3%) of whom were women and 28,969 (58.7%) of whom were men. Men were more likely to be older and had a higher prevalence of paroxysmal atrial fibrillation, prior stroke and uncontrolled hypertension, but had a lower prevalence of congestive heart failure, diabetes and coronary artery disease.

The results show no differences in aborted or canceled procedures between women and men (3% vs. 2.9%). Women were more likely than men to experience a major adverse event (4.1% vs. 2%) or any adverse event (6.3% for women vs. 3.9% for men). Women also were more likely than men to require a hospital stay longer than one day (16% for women vs. 11.6% for men). In addition, although death was rare, it was more common among women than men (0.3% vs. 0.1%).

According to the researchers, women undergoing LAAO had a twofold higher risk of a major adverse event and a greater likelihood of experiencing any in-hospital event. They note that women comprise a larger proportion of patients receiving LAAO implants in real-world practice than in clinical trials, noting that the study’s findings underscore the need to “continue to advocate for increased participation of women in clinical trials to better inform clinical decision-making and adequately delineate sex-based safety and efficacy outcomes.” They conclude that additional research is needed to “identify the reasons for sex-based differences in outcomes and the strategies to reduce the risk of adverse events among women [undergoing LAAO].”

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: Atrial Fibrillation, Coronary Artery Disease, Atrial Appendage, Sex Characteristics, Prevalence, Length of Stay, Stroke, Heart Failure, Registries, Cohort Studies, Diabetes Mellitus, Hypertension, Cardiology, Hospitals, National Cardiovascular Data Registries, LAAO Registry

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