Impact of Age on Clinical Outcomes Following Left Atrial Appendage Occlusion: A Meta-Analysis And Systematic Review of Observational Studies

Left atrial appendage occlusion (LAAO) offers an alternative to oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation; however, the impact of advanced age on outcomes remains uncertain. We conducted a systematic review and meta-analysis to evaluate the effect of age on in-hospital and long-term outcomes following LAAO. A comprehensive search of PubMed and Google Scholar yielded 1,372 studies, of which seven met the inclusion criteria after screening and full-text review. Eligible studies stratified outcomes by age (<75 vs ≥75, <80 vs ≥80, or multilevel age groups), and we analyzed all-cause mortality, stroke/systemic embolism (SE), and major bleeding using relative risks (RRs) with 95% confidence intervals (CI). Long-term mortality was significantly higher among older patients, with mortality rising from 32.4% at age 65-69 to 63.4% in those ≥85 (RR 1.96, 95%CI 1.90-2.03), and from 14.3% <80 to 38.8% ≥80 (RR 2.71, 95%CI 2.24-3.28). Pooled analysis demonstrated substantial heterogeneity for mortality (I² = 80.7%). Stroke/SE rates were modestly elevated with age, including 13.0% in ≥85 vs 5.3% at 65-69 (RR 2.45, 95%CI 2.00-3.00), with moderate heterogeneity across studies (I² = 63.9%). Major bleeding consistently increased in older groups, such as 18.4% ≥85 vs 12.0% at 65-69 (RR 1.53, 95%CI 1.35-1.72) and 22.6% ≥80 vs 12.1% <80 (RR 1.87, 95%CI 1.44-2.41), with high heterogeneity (I² = 83.4%). In-hospital mortality and stroke/SE were low overall but showed age-related increases in large cohorts. A funnel plot suggested no major publication bias. LAAO provides consistent stroke prevention across all ages, but older patients, particularly those ≥80-experience significantly higher mortality and bleeding risks. Age should not contraindicate LAAO but should guide individualized risk-benefit discussions, especially regarding bleeding management and long-term prognosis.