To describe the United States national trends and predictors in the use of left atrial appendage closure (LAAC) among hospitalized atrial fibrillation (AF) patients with CHA₂DS₂Vasc score≥2 from 2005 to 2014.

PROTECT-AF and PREVAIL trials showed non-inferiority of LAAC compared to warfarin. However, relatively little is known regarding utilization of LAAC in AF patients with CHA₂DS₂Vasc≥2 in clinical practice.

We included patients aged≥18 with AF and are candidates for anticoagulation in the US from 2005 to 2014 using the National Inpatient Sample (NIS) database. Primary analysis was the proportion of patients who received LAAC temporally. Survey-weighted logistic regression was used to estimate the rate for each year. Predictors of LAAC were evaluated using logistic regression adjusted for age and sex. Odds of LAAC use were assessed according to patient-level and hospital-level variables, before and after adjusting for covariates.

We included 6,732,801 hospitalizations of which 0.23%(15,549/6,732,801) had LAAC. The proportion of LAAC increased from 0.01% to 0.46% from 2005 to 2014 (p<0.001). In multivariable models, the adjusted odds of LAAC was higher with younger age (per 1-year OR 0.95, 95%CI 0.95-0.96), white race (OR 2.94, 95%CI 2.64-3.29), male sex (OR 1.51, 95%CI 1.46-1.57), private insurance (OR 1.21, 95%CI 1.15-1.27), hospitalization in urban-teaching hospitals (OR 6.92 95% 5.14-9.32) and CHA₂DS₂Vasc≥4 (OR 1.38, 95%CI 1.32-1.45). Conversely, Charlson Comorbidity Index (CCI)≥2 (OR 0.67, 95%CI 0.64-0.70), history of ischemic stroke (OR 0.58, 95%CI 0.52-0.65), intracerebral hemorrhage (OR 0.35, 95%CI 0.17-0.70), and major bleeding (OR 0.34, 95%CI 0.27-0.42) were associated with lower odds of LAAC.