Seslar, Stephen P.

Introduction: There is a variation in cardiovascular outcomes between rural and urban hospitals such as higher mortality for AF. Whether such a relationship exists for safety and outcomes of left atrial appendage occlusion (LAAO) device implantation is unknown. Hypothesis: We hypothesized that LAAO procedure in rural hospitals is associated with worse in-hospital outcomes. Methods: A cross-sectional examination of patients who were hospitalized for LAAO procedure was performed in the National Inpatient Sample between 2016 and 2019 to compare in-hospital outcomes in patients admitted to urban vs rural hospitals. ICD 10 PCS code 02L73DK was used to identify hospitalizations with LAAO procedure. The cohort was further stratified into rural and urban hospitals. Chi-square test and multivariate logistic regression were used to analyze the association and statistical analyses were performed using weighted values. Results: A total of 61,390 hospitalizations for LAAO procedures were identified during the study period. From these, 1185 (1.93%) hospitalizations occurred in rural hospitals. Baseline characteristics and inpatient outcomes are shown in Table 1. LAAO in rural hospitalizations was associated with significantly higher in-hospital mortality [OR 2.94 (1.17-7.14), p<0.001*]. This associated persisted even after adjusting for significant baseline characteristics [aOR 3.55 (1.42-8.84), p=0.006*). Conclusions: In-hospital mortality was significantly higher in patients undergoing LAAO in rural hospital. Further studies are needed to validate these findings in a prospective manner.