Impact of Age on Clinical Outcomes Following Left Atrial Appendage Occlusion: A MetaAnalysis And Systematic Review of Observational Studies

Q: What clinical question does this study address?

The study evaluates how patient age affects in-hospital and long-term clinical outcomes following left atrial appendage occlusion (LAAO), including mortality, stroke/systemic embolism, and major bleeding.

Q: How were studies selected for the meta-analysis?

A comprehensive literature search in PubMed and Google Scholar identified 1,372 studies, and seven observational studies met inclusion criteria after screening and full-text review.

Q: What are the key outcome trends by age group?

Long-term mortality increased significantly in older groups, stroke/systemic embolism rates were modestly higher with age, and major bleeding consistently rose in older age strata. In-hospital mortality and stroke/systemic embolism were low overall but showed age-related increases in larger cohorts.

Sep 29, 2026

Uploaded by Ezra

Left atrial appendage occlusion (LAAO) offers an alternative to oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation, yet the influence of advanced age on outcomes remains uncertain. A systematic review and meta-analysis evaluated the effect of age on in-hospital and long-term outcomes after LAAO. PubMed and Google Scholar searches identified 1,372 studies, with seven meeting inclusion criteria. Older patients had higher long-term mortality, increased stroke/systemic embolism rates, and greater major bleeding risk. Substantial heterogeneity was observed across studies, and funnel plots suggested no major publication bias. Results indicate age should guide individualized risk-benefit discussions rather than contraindicate LAAO.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Introduction And Background

Review

Methods

Study Design

Search Strategy

Review began 11/04/2025 Review ended 12/03/2025 Published 12/06/2025 © Copyright 2025 Alseid et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98603 Open Access Review Article Impact of Age on Clinical Outcomes Following Left Atrial Appendage Occlusion: A MetaAnalysis And Systematic Review of Observational Studies Amro Alseid 1, Ibrahim O. Abunemr 2, Rakesh Prashad 3 1. Internal Medicine, University of Central Florida College of Medicine, Ocala, USA 2. Internal Medicine, University of Jordan, Amman, JOR 3. Cardiology, University of Central Florida College of Medicine, Ocala, USA Corresponding author: Amro Alseid, [assayedamr@gmail.com](assayedamr@gmail.com) Abstract Left atrial appendage occlusion (LAAO) offers an alternative to oral anticoagulation for stroke prevention inpatients with non-valvular atrial fibrillation; however, the impact of advanced age on outcomes remains uncertain. We conducted a systematic review and meta-analysis to evaluate the effect of age on in-hospital and long-term outcomes following LAAO. A comprehensive search of PubMed and Google Scholar yielded 1,372 studies, of which seven met the inclusion criteria after screening and full-text review. Eligible studies stratified outcomes by age (<75 vs ≥75, <80 vs ≥80, or multilevel age groups), and we analyzed all-cause mortality, stroke/systemic embolism (SE), and major bleeding using relative risks (RRs) with 95% confidence intervals (CI) . Long-term mortality was significantly higher among older patients, with mortality rising from 32.4% at age 65-69 to 63.4% in those ≥85 (RR 1.96, 95%CI 1 .90-2.03), and from 14.3% <80 to 38.8% ≥80 (RR 2.71, 95%CI 2 .24-3.28) . Pooled analysis demonstrated substantial heterogeneity for mortality (I² = 80 . 7%) . Stroke/SE rates were modestly elevated with age, including 13.0% in ≥85 vs 5.3% at 65-69 (RR 2.45, 95%CI 2.00-3.00), with moderate heterogeneity across studies (I² = 63 .9%) . Major bleeding consistently increased in older groups, such as 18.4% ≥85 vs 12.0% at 65-69 (RR 1.53, 95%CI 1 .35-1. 72) and 22.6% ≥80 vs 12. 1% <80 (RR 1.87, 95%CI 1 .44-2.41), with high heterogeneity (I² = 83 .4%) . In-hospital mortality and stroke/SE were low overall but showed age-related increases in large cohorts. A funnel plot suggested no major publication bias. LAAO provides consistent stroke prevention across all ages, but older patients, particularly those ≥80-experience significantly higher mortality and bleeding risks. Age should not contraindicate LAAO but should guide individualized risk-benefit discussions, especially regarding bleeding management and long-term prognosis. Categories: Cardiology, Geriatrics, Internal Medicine Keywords: age factors, atrial fibrillation, left atrial appendage occlusion, long-term outcomes, major bleeding, metaanalysis, mortality, stroke Introduction And Background Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting over 30 million people worldwide and significantly increasing the risk of ischemic stroke [1] . The left atrial appendage (LAA) is the primary source of thromboembolism in non-valvular AF [2], and anticoagulation remains the cornerstone of stroke prevention [3,4] . However, a substantial proportion of patients, particularly older adults, have contraindications to long-term oral anticoagulation due to elevated bleeding risk, falls, frailty, or patient preference [5-7]. In this context, LAA occlusion (LAAO) has emerged as a non-pharmacologic alternative for stroke prevention. Large prospective trials and registry data have demonstrated the efficacy and safety of LAAO, particularly using the WATCHMAN device (Boston Scientific Corporation, Marlborough, Massachusetts, United States) and similar systems [8

FAQs

What clinical question does this study address?

The study evaluates how patient age affects in-hospital and long-term clinical outcomes following left atrial appendage occlusion (LAAO), including mortality, stroke/systemic embolism, and major bleeding.

How were studies selected for the meta-analysis?

A comprehensive literature search in PubMed and Google Scholar identified 1,372 studies, and seven observational studies met inclusion criteria after screening and full-text review.

What are the key outcome trends by age group?

Long-term mortality increased significantly in older groups, stroke/systemic embolism rates were modestly higher with age, and major bleeding consistently rose in older age strata. In-hospital mortality and stroke/systemic embolism were low overall but showed age-related increases in larger cohorts.

Sep 29, 2026

Uploaded by Ezra