Abstract Body (Do not enter title and authors here): Introduction:
Gender and racial disparities have been shown to impact outcomes with percutaneous left atrial appendage closure (LAAC) though no studies have directly evaluated the role of socioeconomic disadvantage. The Social Deprivation Index (SDI) is a metric designed to quantify socioeconomic variation in health outcomes. We aimed to evaluate if SDI increases the risk of readmission within one year after LAAC in patients with atrial fibrillation (AF).
Methods:
Patients ages ≥18 were identified in the Healthcare Cost and Utilization Project State Inpatient Databases in New York (NY) and Florida (FL) from 2016-2019 with follow-up into 2020. These states were chosen due to availability for linkage of the 2018 SDI data. International Classification of Diseases 10 codes for AF and LAAC were used. The risk of readmission was assessed using multivariable Cox proportional hazards regression with covariates age, sex, race, insurance, Charlson Comorbidity Index (0 vs ≥ 1 comorbidity), and SDI deciles. SDI is scored 1-100 with higher scores representing more disadvantage.
Results:
7,786 patients underwent LAAC in NY and FL 2016-2019. The readmission rate at one, three, and twelve months was 10.1%, 21.5%, and 44%. The most common admitting diagnoses at readmission were dyspnea/chest pain (11.4%) and GI bleed (8.8%). Female sex, African American race, ≥ 1 Charlson comorbidity, and those with from areas with a higher SDI had a higher one-, three-, and twelve-month risk of readmission. Those with federal insurance had a higher three- and twelve-month risk of readmission.
Conclusion:
After adjustment, socioeconomic disadvantage was observed to place patients at higher risk of readmission within one year after LAAC. GI bleed remains a common complication post LAAC. Given the link between differential care and healthcare disparities, it is essential to raise awareness to ensure successful post-procedure management and equitable cardiovascular care.