Associazione Nazionale Medici Cardiologi Ospedalieri

congress.anmco.it

CONGRESS ABSTRACT

CONGRESS ABSTRACT

IMPACT OF ADAPTED CLINICAL MANAGEMENT ON OUTCOMES IN LEFT ATRIAL APPENDAGE CLOSURE (LAAC): A FOCUS ON PATIENT’S COMORBIDITY AND LENGTH OF STAY

Ascanio Rocco Massa (Ms) – Fondazione Toscana Gabriele Monasterio | Tonelli Giulia Massa (Ms) – Ftgm | Campi Marta Massa (Ms) – Ftgm | Tarabella Angelica Massa (Ms) – Ftgm | Borghetti Siria Massa (Ms) – Ftgm | Trimarchi Giancarlo Massa (Ms) – Ftgm | Benedetti Giovanni Massa (Ms) – Ftgm | Pastormerlo Luigi Emilio Massa (Ms) – Ftgm | Baratta Stefania Massa (Ms) – Ftgm | Paradossi Umberto Massa (Ms) – Ftgm | Berti Sergio Massa (Ms) – Ftgm | Durante Angela Massa (Ms) – Ftgm
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Background: Left atrial appendage closure (LAAC) is a standard treatment for patients with atrial fibrillation (AF) facing high risks of both thromboembolism and bleeding. The procedure is performed via a femoral venous approach, guided by intracardiac or transesophageal echocardiography (TEE). Essential to successful outcomes are nursing management focused on patient monitoring, complication detection, pain control and vascular access care. Objective: This study aimed to evaluate shifts in patient profiles, clinical management and procedural results for LAAC performed at our institution between 2022 and 2025. Methods: We conducted a comparative analysis of two consecutive two-year cohorts (2022–2023 vs. 2024–2025), focusing on baseline patient characteristics, procedural success rates, intrahospital events and average length of stay. Results: The later cohort (2024–2025) presented with slightly older patients (78.5 vs. 77.4 years) and a similar male predominance (63% vs. 60%) respec t the first cohort . Notably, the comorbidity burden significantly increased, evidenced by a higher Charlson Comorbidity Index (5.14 vs. 4.33, p <0.05). Changes in AF patterns included a decrease in permanent cases (51.4% vs 42.6%, p <0.05) , increase in paroxysmal AF (23.7% vs 44.4%, p <0.05) and a substantial rise in cancer patients (29.3% vs 72.2%, p <0.05) in the last two years. Stroke and bleeding risk scores (CHA2DS2-VASc and HAS-BLED) remained consistent. Reflecting evolving post-LAAO protocols, there was increased baseline use of NOACs (26.7% vs 64.8%, p <0.05) and increased use of aspirin at discharge (67.9% vs 80.0%, p <0.05). Procedural complexity rose due to the adoption of newer device technologies, increased TEE utilization (10.4% vs 21.3%, p <0.05), and longer procedural times (66.7 vs 78.3 min, p <0.05). Despite this increased complexity, procedural success remained high (~98%), the hospital stay was stable (~3.5 days) and major complication rates were unchanged (5.1% vs. 5.6%, p =1.00), with no in-hospital mortality. Conclusion: Despite the increasing complexity of patients over this four-year period, favorable outcomes and stable hospital lenght of stay were successfully maintained thanks to the optimization of nursing and medical management and advances in procedural techniques. Integrating nursing fragility scores during the pre-admission phase enables more accurate patient stratification, helping prevent adverse events post-procedure.