Left Atrial Appendage Closure Devices Effective at Preventing Stroke in Very Elderly Patients

Left atrial appendage occlusion (LAAO) in elderly patients (80 and older) with atrial fibrillation (AFib) demonstrates similar efficacy, complications, and mortality rates to those seen in younger patients, according to a study which was presented at AHA 2024.

“Limited single-center and observational studies suggest that (LAAO) may be a safe alternative in selected elderly patients with AFib,” the researchers noted.

Researchers performed a systematic search of PubMed, Science Direct, and CENTRAL for studies that reported outcomes comparing octogenarian and nonagenarian patients who underwent LAAO with their younger counterparts. Overall, they assessed seven studies comprised of  6,126 patients (31% were ≥80 years old). The researchers used Review Manager 5.4 software to analyze outcomes.

The findings of pooled analysis showed no notable difference in the odds of mortality (OR = 1.30; 95% CI [0.49, 3.47]; p = 0.60), all causes of stroke (OR = 1.22; 95% CI [0.61, 2.43]; p= 0.57), vascular complications (OR = 1.70; 95% CI [0.61,4.73]; p=0.31), and pericardial complications (OR = 1.45; 95% CI [0.69, 3.05]; p = 0.33). However, they find a significant difference in the odds of major bleeding events (OR 1.88; 95% CI [1.51, 2.34]; p<0.00001) in patients aged >80 compared to younger patients.

“The findings support the safety and effectiveness of LAAO as a viable alternative for stroke prevention in very elderly patients, with additional consideration needed for those with increased susceptibility to bleeding events,” the researchers concluded.

Reference

Barrera N, Jimenez Y, Koyner F, et al. Efficacy and Safety of Left Atrial Appendage Closure Devices in Patients Aged Above 80 Years: A Systematic Review and Meta-Analysis. Abstract #Su2078. Presented at the American Heart Association Scientific Sessions 2024; November 16-18, Chicago, Illinois.