Long‐term quality of life in octogenarians and nonagenarians with nonvalvular atrial fibrillation following WATCHMAN™ device implantation

Abstract

Objectives: To assess the impact of WATCHMAN™ on quality of life (QoL) in octogenarians and nonagenarians.Background: QoL after WATCHMAN™ device in the elderly remains unknown.Methods: This is a prospective and retrospective cohort study of patients that underwent WATCHMAN™ implantation in a tertiary cardiovascular center from April 1, 2015 to September 27, 2017. The primary outcome was a prospective assessment of QoL via the SF-12v2 Health Survey (SF-12v2) in those aged ≥80 and ≥90 years. Secondary outcomes include major bleeding, stroke, vascular complications, pericardial effusion, device related thrombus (DRT), prolonged length of stay (LOS), acute kidney injury (AKI), and recurrent hospitalizations. Results: This cohort of 151 patients included 48/151 (32%) females with a mean age of 80 AE 7.7 years. Mean CHA 2 DS 2 -VASc was 4.38 AE 1.36 and mean HAS-BLED was 3.27 AE 1.17. Octogenarians 65/81(80%) and nonagenarians 16/81(20%) comprised 81/151(54%) of patients (mean age 86 AE 4.3 years) from which 36/65 (55%) octogenarians and 10/16 (63%) nonagenarians completed SF-12v2 evaluation at 22 AE 10 and 30 AE 10-months. Octogenarians demonstrated enhanced physical component scores (PCS), and nonagenarians equal PCS versus the age-adjusted norm (45.43 AE 9.84 versus 38.68 AE 11.04, P = 0.0003, and 41.26 AE 12.36 versus 38.68 AE 11.04, P = 0.6463, respectively). The mental component scores (MCS) of octogenarians and nonagenarians remained comparable (51.80 AE 9.56 and 48.97 AE 9.92 versus 50.06 AE 10.94, respectively, P = 0.4659). No stroke, vascular complications, pericardial effusions, or readmissions related to WATCHMAN™ occurred. No difference among patients <80, ≥80, and ≥90 years was found in major bleeding events, DRT, prolonged LOS, or AKI (P = 0.0569, 0.116, 0.498, and 0.795, respectively).Conclusions: Octogenarians and nonagenarians experience favorable long-term QoL after WATCHMAN™, with acceptable bleeding risk and low incidence of procedure-related complications. K E Y W O R D Sbleeding, elderly patients, left atrial appendage closure, stroke

Left Atrial Appendage Closure for Atrial Fibrillation in the Elderly >75 Years Old: A Meta-Analysis of Observational Studies

“…Eighteen studies were excluded because no outcomes of interest were provided. Finally, 12 articles—11 observational studies and 1 analysis matched on propensity scores—were used in our study [ 14 , 15 , 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The characteristics of the study are shown in Table 1 .…”

“…Gastrointestinal bleeding dominates in our included studies. In the study of Ramos Tuarez et al, major bleeding patients did not rebleed after changing the anticoagulation regimen [ 21 ]. In the study by Dai et al, there was one case of gastrointestinal bleeding in the elderly group, which improved after treatment [ 24 ].…”

“… Forest plot showing the effect of left atrial appendage closure on ( a ) successful implantation LAAC rates, ( b ) stroke, and ( c ) pericardial effusion/tamponade [ 14 , 15 , 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. …”

“… Forest plot showing the effect of left atrial appendage closure on ( a ) periprocedural mortality, ( b ) major bleeding events, and ( c ) vascular access complication [ 14 , 15 , 16 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. …”