{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T22:34:51Z","timestamp":1792017291283,"version":"4.4.0"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Transcatheter left atrial appendage occlusion (LAAO) is an alternative to oral anticoagulants (OACs) for stroke prevention in patients with atrial fibrillation, but the predictors of LAAO use in routine care are unclear. We aimed to assess the utilization trends of LAAO and compare the change in characteristics of LAAO users versus OACs since its marketing.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>\n              Using the US Medicare claims database (March 15, 2015, to December 31, 2020), we identified patients with atrial fibrillation, \u226565 years, and CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score \u22652 (men) or \u22653 (women), with either first implantation of an LAAO device or initiation of OACs, including apixaban, dabigatran, rivaroxaban, edoxaban, or warfarin. Patient characteristics, measured 365 days before the first LAAO or OAC use date, were compared using logistic regression.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>There were 30\u2005058 LAAO recipients (mean age, 77.74 years; female, 42.1%) and 792\u2005600 OAC initiators (mean age, 78.48; female, 53.3%). In 2020, patients had higher odds of initiating LAAO use than in 2015 (0.52 versus 9.32%; adjusted odds ratio [aOR], 13.64 [95% CI, 12.56\u201314.81]). Old age (ie, &gt;85 versus 65\u201375 years; aOR, 0.84 [95% CI, 0.80\u20130.88]), female sex (aOR, 0.74 [95% CI, 0.71\u20130.76]), Black race (aOR, 0.63 [95% CI, 0.58\u20130.68]) versus White race, and Medicaid eligibility (aOR, 0.61 [95% CI, 0.58\u20130.64]) were associated with lower odds of receiving LAAO. Among clinical characteristics, frailty, cancer, fractures, and venous thromboembolism were associated with lower odds of LAAO use, while history of intracranial and extracranial bleeding, coagulopathy, and falls were associated with higher odds of receiving LAAO.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Among patients with atrial fibrillation receiving stroke-preventive therapy, LAAO use increased rapidly from 2015 to 2020 and was positively associated with the risk factors for OAC complications but negatively associated with old age, advanced frailty, and cancer. Black race and female sex were associated with a lower likelihood of receiving LAAO.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.123.010279","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T10:01:06Z","timestamp":1709632866000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Patient Characteristics Associated With Using Transcatheter Left Atrial Appendage Occlusion Versus Oral Anticoagulants for Atrial Fibrillation"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4564-3715","authenticated-orcid":true,"given":"Kueiyu Joshua","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA (K.J.L., J.A., S.K.S., P.A., Y.Z., T.N.T., S.S.)"},{"name":"Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (K.J.L., D.E.S.); Division of Cardiology and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6145-4848","authenticated-orcid":true,"given":"Daniel E.","family":"Singer","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (K.J.L., D.E.S.); Division of Cardiology and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0255-2346","authenticated-orcid":true,"given":"Jerry","family":"Avorn","sequence":"additional","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital, Boston, MA (K.J.L., J.A., S.K.S., P.A., Y.Z., T.N.T., S.S.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5605-4724","authenticated-orcid":true,"given":"E. 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