Trends in percutaneous left atrial appendage occlusion and 1-year mortality 2013–2021: A nationwide observational study

Background Percutaneous left atrial appendage occlusion (LAAO) is increasingly used for stroke prevention in patients with atrial fibrillation and anticoagulant-related complications. Yet, real-life studies evaluating changes in patient characteristics and indications for LAAO remain scarce. Methods To evaluate changes in patient characteristics and indications for LAAO defined as 2-year history of intracerebral bleeding, any ischemic stroke/systemic embolism (SE), any non-intracerebral bleeding, other indication, and 1-year mortality. All patients undergoing percutaneous LAAO in Denmark from 2013 to 2021 were stratified into the following year groups: 2013–2015, 2016–2018, and 2019–2021. Results In total, 1465 patients underwent LAAO. Age remained stable (2013–2015: 74 years versus 2019–2021: 75 years). Patients' comorbidity burden declined, exemplified by CHA2DS2-VASc ≥4 and HAS-BLED ≥3 decreased from 56.7% and 63.7% in 2013–2015 to 40.3% and 45.8% in 2019–2021. Indications for LAAO changed over time with other indication comprising 44.7% in 2019–2021; up from 26.9% in 2013–2015. Conversely, fewer patients had an indication of any ischemic stroke/SE (2013–2015: 30.8% vs 2019–2021: 20.3%) or any non-intracerebral bleeding (2013–2015: 29.4% vs 2019–2021: 23.4%). 1-year mortality was 11.3% for any non-intracerebral bleeding and 6.2% for other indication. Conclusion The LAAO patient-profile has changed considerably. Age remained stable, while comorbidity burden decreased during the period 2013–2021. LAAO is increasingly used in patients with no clinical event history and mortality differs according to indication. Selection of patients to LAAO should be done carefully, and contemporary real-life studies investigating clinical practice could add important insights.