Inpatient Outcomes and Complications After Left Atrial Appendage Occlusion in Rural Versus Urban Hospitals in the United States

BACKGROUND: Disparities in management of atrial fibrillation in rural and urban hospitals across the U.S. have been reported. However, studies investigating disparities regarding outcomes and complications after left atrial appendage occlusion (LAAO) based on hospital location are lacking. OBJECTIVE: To evaluate differences in outcomes and complications related to LAAO among rural and urban hospitals. METHODS: The National Inpatient Sample was used to identify patients who underwent LAAO implantations in the U.S. from 2016-2020. Study endpoints assessed included inpatient complications, outcomes, and resource utilization after LAAO procedures among rural and urban hospitals. RESULTS: From 2016-2020, there were a total of 87 315 and 1985 LAAO device placements in urban and rural hospitals, respectively. Baseline characteristics were similar among both groups, with a few exceptions. After multivariable adjustment for confounders, odds of inpatient complications and mortality were similar among both groups. However, rural LAAO recipients experienced greater rates of discharge to an acute care facility (3.3% vs 2.4%, p = 0.01), as well as lower costs (aOR: 0.58, 95% CI: 0.49-0.69) and length of stay (aOR: 0.89, 95% CI: 0.81-0.98). CONCLUSIONS: A majority of LAAO implantations occurred in urban hospitals in the U.S. Baseline characteristics and adjusted odds of inpatient complications and mortality were similar in rural and urban recipients. However, important differences were described regarding resource utilization and disposition. Further investigation into the specific factors driving these inequities is encouraged to promote improved access to and outcomes of cardiovascular care for rural residents.