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Racial and Ethnic Differences in Left Atrial Appendage Occlusion Wait Time, Complications, and Periprocedural Management
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  • Abdullah Haddad,
  • Matthew Bocchese,
  • Rebecca Garber,
  • Brian O'Neill,
  • George Yesenosky,
  • Pravin Patil,
  • Martin Keane,
  • Sabrina Islam,
  • Jacqueline Sherrer,
  • Anuj Basil,
  • Chethan Gangireddy,
  • Joshua Cooper,
  • Edmond Cronin,
  • Isaac Whitman
Abdullah Haddad
Temple University Hospital
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Matthew Bocchese
Temple University Hospital
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Rebecca Garber
Temple University Hospital
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Brian O'Neill
Henry Ford Health System
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George Yesenosky
Temple University Hospital
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Pravin Patil
Temple University Hospital
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Martin Keane
Temple University Hospital
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Sabrina Islam
Temple University Hospital
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Jacqueline Sherrer
Temple University Hospital
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Anuj Basil
Temple University Hospital
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Chethan Gangireddy
Temple University Hospital
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Joshua Cooper
Temple University Hospital
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Edmond Cronin
Temple University Hospital
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Isaac Whitman
Temple University Hospital
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Abstract

Introduction: Non-white patients are underrepresented in left atrial appendage occlusion (LAAO) trials, and racial disparities in LAAO periprocedural management are unknown. Methods: We assessed sociodemographics and comorbidities of consecutive patients at our institution undergoing LAAO between 2015 – 2020, then in adjusted analyses, compared procedural wait time, procedural complications, and post-procedure oral anticoagulation (OAC) use in whites versus non-whites. Results: Among 109 patients undergoing LAAO (45% white), whites were less likely to have heart failure than non-whites (18% vs. 48%, p=0.001), prior stroke (14% vs. 43%, p=0.001), or end stage renal disease (0 vs. 20%, p<0.001). Whites had lower CHA2DS2VASc scores, on average (4.0 vs. 4.8, p=0.006). There was no difference in median time from index event or initial outpatient cardiology encounter to LAAO procedure (whites 10.5 vs. non-whites 13.7 months, p=0.9; 1.9 vs 1.8 months, p=0.6, respectively), and there was no difference in procedural complications (whites 4% vs. non-whites 5%, p=0.33). After adjusting for CHA2DS2VASc score, OAC use at discharge tended to be higher in whites (OR 2.4, 95%CI [0.9-6.0], p=0.07). When restricting the analysis to those with prior gastrointestinal (GI) bleed, adjusting for CHA2DS2VASc score and GI bleed severity, whites had a nearly five-fold odds of being discharged on OAC (OR 4.6, 95% CI [1-21.8], p=0.05). Conclusion: Despite an increased prevalence of comorbidities amongst non-whites, wait time for LAAO and procedural complications were similar in whites versus non-whites. Among those with prior GI bleed, whites were nearly five-fold more likely to be discharged on OAC than non-whites.

Peer review status:UNDER REVIEW

21 Aug 2020Submitted to Journal of Cardiovascular Electrophysiology
24 Aug 2020Assigned to Editor
24 Aug 2020Submission Checks Completed
30 Aug 2020Reviewer(s) Assigned
24 Sep 2020Review(s) Completed, Editorial Evaluation Pending