BACKGROUND:Transcatheter left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation, but the predictors of LAAO use in routine care are unclear. We aimed to assess the utilization trends of LAAO and compare the change in characteristics of LAAO users versus OACs since its marketing.METHODS:Using the US Medicare claims database (March 15, 2015, to December 31, 2020), we identified patients with atrial fibrillation, ≥65 years, and CHA₂DS₂-VASc score ≥2 (men) or ≥3 (women), with either first implantation of an LAAO device or initiation of OACs, including apixaban, dabigatran, rivaroxaban, edoxaban, or warfarin. Patient characteristics, measured 365 days before the first LAAO or OAC use date, were compared using logistic regression.RESULTS:There were 30 058 LAAO recipients (mean age, 77.74 years; female, 42.1%) and 792 600 OAC initiators (mean age, 78.48; female, 53.3%). In 2020, patients had higher odds of initiating LAAO use than in 2015 (0.52 versus 9.32%; adjusted odds ratio [aOR], 13.64 [95% CI, 12.56–14.81]). Old age (ie, >85 versus 65–75 years; aOR, 0.84 [95% CI, 0.80–0.88]), female sex (aOR, 0.74 [95% CI, 0.71–0.76]), Black race (aOR, 0.63 [95% CI, 0.58–0.68]) versus White race, and Medicaid eligibility (aOR, 0.61 [95% CI, 0.58–0.64]) were associated with lower odds of receiving LAAO. Among clinical characteristics, frailty, cancer, fractures, and venous thromboembolism were associated with lower odds of LAAO use, while history of intracranial and extracranial bleeding, coagulopathy, and falls were associated with higher odds of receiving LAAO.CONCLUSIONS:Among patients with atrial fibrillation receiving stroke-preventive therapy, LAAO use increased rapidly from 2015 to 2020 and was positively associated with the risk factors for OAC complications but negatively associated with old age, advanced frailty, and cancer. Black race and female sex were associated with a lower likelihood of receiving LAAO.

中文翻译：

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使用经导管左心耳封堵术与口服抗凝剂治疗心房颤动相关的患者特征

背景：经导管左心耳封堵术 (LAAO) 是口服抗凝剂 (OAC) 的替代方案，用于预防房颤患者卒中，但 LAAO 在常规护理中使用的预测因素尚不清楚。我们旨在评估 LAAO 的使用趋势，并比较自上市以来 LAAO 用户与 OAC 的特征变化。 方法：使用美国医疗保险索赔数据库（2015 年 3 月 15 日至 2020 年 12 月 31 日），我们确定了患有心房颤动的患者。颤动，≥65 岁，且 CHA ₂ DS ₂ -VASc 评分≥2（男性）或≥3（女性），首次植入 LAAO 装置或启动 OAC，包括阿哌沙班、达比加群、利伐沙班、依多沙班或华法林。使用逻辑回归对首次使用 LAAO 或 OAC 日期前 365 天测量的患者特征进行比较。 结果：共有 30 058 名 LAAO 接受者（平均年龄 77.74 岁；女性，42.1%）和 792 600 名 OAC 发起者（平均年龄78.48；女性，53.3%）。 2020 年，患者开始使用 LAAO 的几率比 2015 年更高（0.52 对比 9.32%；调整后的比值比 [aOR]，13.64 [95% CI，12.56–14.81]）。老年（即 >85 岁与 65–75 岁；aOR，0.84 [95% CI，0.80–0.88]）、女性（aOR，0.74 [95% CI，0.71–0.76]）、黑人种族（aOR，0.63） [95% CI, 0.58–0.68]）与白人种族和医疗补助资格（aOR, 0.61 [95% CI, 0.58–0.64]）相比，接受 LAAO 的几率较低。在临床特征中，虚弱、癌症、骨折和静脉血栓栓塞与使用 LAAO 的几率较低相关，而颅内和颅外出血史、凝血功能障碍和跌倒与接受 LAAO 的几率较高相关。结论：在房颤患者中在接受中风预防治疗的患者中，LAAO 的使用从 2015 年到 2020 年迅速增加，与 OAC 并发症的危险因素呈正相关，但与老年、晚期虚弱和癌症呈负相关。黑人种族和女性接受 LAAO 的可能性较低。