Left atrial appendage closure with the watchman device reduces atrial fibrillation management costs

• Published in: Clinical research in cardiology Vol. 111; no. 1; pp. 105 - 113
• Main Authors: D´Ancona, Giuseppe, Safak, Erdal, Weber, Denise, Arslan, Fatih, Kische, Stephan, Darius, Harald, Behrens, Steffen, Zohlenhöfer-Momm, Dietlind, Ortak, Jasmin, Kugler, Joachim, Ince, Hüseyin
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2022; Springer Nature B.V
• Subjects: Aged; Atrial Appendage - surgery; Atrial Fibrillation - mortality; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiac Catheterization; Cardiology; Cost analysis; Costs; Costs and Cost Analysis; Female; Fibrillation; Germany; Hospitalization; Hospitalization - economics; Humans; Male; Medicine; Medicine & Public Health; Mortality; Original Paper; Patients; Prostheses and Implants - economics; Regression analysis; Risk assessment; Survival; Germany; Occlusion; Appendage; Costs; Fibrillation; Percutaneous; Atrial; Factors; DRG; Risk
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-021-01943-7

Aims To report hospitalization costs of patients with non-valvular atrial fibrillation (AF) submitted to percutaneous left atrial appendage closure (LAAC) with the Watchman device. Methods Pre- and post-procedural hospitalization AF-related costs were calculated using the DRG system (diagnosis-related groups) and compared. Results Between 2012 and 2016, 677 non-valvular AF patients underwent LAAC. Median time from first cardiac hospitalization to LAAC was 5.9 years (IQR 1.6–9.1) and median follow-up after LAAC was 4.8 years (IQR 3.6–5.6). LAAC mortality was 1.3% and follow-up mortality 16.9%. Median pre-LAAC hospitalization cost was € 17,867 (IQR € 7512–35,08) and post-LAAC € 8772 (IQR € 1183–25,159) ( p  < 0.0001). Annualized cost pre-LAAC was 3773 € (IQR € 1644–8,493) and post-LAAC 2,001 € (IQR € 260–6913) ( p  < 0.0001). Follow-up survivors had significantly lower post-LAAC costs ( p  < 0.0001) and after a survival cut-off time of 4.6 years LAAC procedural and post-procedural hospitalization costs achieved parity with pre-LACC costs (AUC 0.64; p  = 0.02). CHA2DS2-VASc score ( B  = 0.04; p  = 0.02; 95% CI 0.006–0.08), and HAS-BLED score ( B  = 0.08; p  = 0.004; 95% CI 0.02–0.14) were independent determinants for annualized hospitalization costs post-LAAC. At Cox-regression analysis the DRG mean clinical complexity level (CCL) was the only independent determinant for follow-up mortality (OR = 2.2; p  < 0.0001; 95% CI 1.6–2.8) with a cut-off value of 2.25 to predict follow-up mortality (AUC 0.72; p  < 0.0001; Spec. 70%; Sens. 70%). Conclusion Hospitalization costs pre-LAAC are consistent, and after LAAC, they are significantly reduced. Costs seem related to the patient's risk profile at the time of the procedure. With the increase in post-LAAC survival time, the procedure becomes economically more profitable. Graphic abstract