Standard Medication Outperforms Minimally Invasive Procedure for High-Risk Atrial Fibrillation Patients

The CLOSURE-AF trial, conducted across 42 healthcare sites in Germany from March 2018 to April 2024, revealed that standard medical care including anticoagulant blood thinners when eligible provided better outcomes than left atrial appendage closure for older atrial fibrillation patients at high risk of stroke and bleeding. More than 900 adults with an average age of 78 years participated in the study, with 39% being women, and were followed for a median of three years. Researchers compared the frequency of stroke, life-threatening blood clots, cardiovascular or unexplained death, and major bleeding between the two treatment groups.

Study lead researcher Ulf Landmesser, M.D., chairman of the department of cardiology at Deutsche Herzzentrum Charité, expressed surprise at the findings, noting that the research team had expected catheter-based LAA closure would be comparable to physician-directed standard medical care. The procedure, which seals off a small pouch in the heart called the left atrial appendage where blood clots typically form in atrial fibrillation patients, had shown promise as an alternative treatment option. According to the American Heart Association's 2025 Heart Disease and Stroke Statistics report, an estimated five million people in the United States currently live with atrial fibrillation, with projections indicating more than 12 million will have the condition by 2030.

The clinical significance of these findings lies in providing clearer guidance for treating older patients with complex medical profiles. While blood thinners effectively reduce stroke risk in atrial fibrillation patients, they can cause severe bleeding in some individuals, prompting researchers to explore alternative treatments like LAA closure. However, the study demonstrated that standard care achieved superior prevention of stroke, systemic embolism, cardiovascular or unexplained death, or major bleeding compared to the procedure. Landmesser emphasized that the results specifically apply to older patients at very high risk of bleeding and stroke, noting that outcomes may differ for lower-risk patients, with studies investigating this currently underway.

The research highlights the importance of individualized treatment approaches for atrial fibrillation management. Additional information about the study can be found in the abstract presented at the scientific sessions. It is important to note that the findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal, as abstracts presented at American Heart Association scientific meetings are not peer-reviewed. The association maintains strict policies to prevent any donations from influencing its scientific content, with overall financial information available here.