Among patients undergoing left atrial appendage occlusion (LAAO), rates of procedural success were similar across racial and ethnic groups, but Black patients had higher rates of death and bleeding at one year, according to a recent study published in the Journal of the American Heart Association.

Oluseun O. Alli, MBBS, FACC, included a total of 97,185 patients (90% White, 3.9% Black, 2.9% Hispanic/Latinx) from the ACC’s LAAO Registry who underwent WATCHMAN FLX implantation through September 2022. They assessed differences in use of LAAO and outcomes at one year by race and ethnicity.

Adjusted risk of death and bleeding was significantly higher in Black patients vs. White patients at one year (death: hazard ratio [HR], 1.26 [95% CI, 1.06-1.50]; bleeding: HR, 1.36 [95% CI, 1.15-1.60]) while Hispanic and White patients exhibited similar risk. Risk of stroke at one year was similar among all three groups.

The authors note that “Black patients were more commonly discharged on anticoagulation plus aspirin or dual antiplatelet therapy instead of anticoagulation alone, which has been previously reported to be associated with higher rates of bleeding after LAAO.”

Overall, Black and Hispanic patients who underwent the procedure were younger and had significantly higher comorbidities when compared with White patients. They also made up a disproportionately small fraction of all patients who undergo LAAO relative to their proportion of the U.S. population.

“The racial and ethnic representation among WATCHMAN FLX recipients in this study mirror the low enrollment of racial and ethnic minority patients in clinical trials involving these devices,” state the authors. “An important consideration that affects access of racial and ethnic minority patients to LAAO procedures is the location of hospitals/centers that perform the procedures.”

Keywords: National Cardiovascular Data Registries, LAAO Registry, Atrial Appendage