Standard Care Beats Heart Procedure for High-Risk AFib Patients

In a significant development for cardiovascular care, new research presented at the American Heart Association's Scientific Sessions 2025 reveals that standard medical treatment outperforms a promising minimally invasive procedure for older patients with atrial fibrillation who face high risks of both stroke and bleeding. The CLOSURE-AF trial, conducted across 42 healthcare sites in Germany and involving over 900 adults with an average age of 78, compared catheter-based left atrial appendage closure against physician-directed standard care that included anticoagulant blood thinners when appropriate. Surprisingly, the study found that standard care was more effective at preventing stroke, systemic embolism, cardiovascular or unexplained death, and major bleeding than the procedure that seals off the left atrial appendage - the small heart pouch where most blood clots form in people with irregular heart rhythms.

The findings challenge previous assumptions about the effectiveness of left atrial appendage closure for high-risk atrial fibrillation patients. Study lead researcher Ulf Landmesser, M.D., chairman of cardiology at Deutsche Herzzentrum Charité in Berlin, noted that while they expected the catheter-based procedure to be comparable to standard medical care, this was not the case for this specific patient population. The research followed participants for a median of three years, with 39% of the study population being women, providing robust data on long-term outcomes. The study's failure to demonstrate non-inferiority for the procedure marks a crucial turning point in how clinicians might approach treatment decisions for this vulnerable patient group.

It's important to note that these findings represent preliminary research presented as an abstract at the American Heart Association's Scientific Sessions and await full peer-reviewed publication. The researchers emphasized that the results may not apply to lower-risk patients or future procedural techniques, and ongoing studies continue to explore LAA closure in combination with blood thinners for very high-risk individuals. With atrial fibrillation affecting an estimated five million Americans and projected to impact over 12 million by 2030 according to the Association's 2025 Heart Disease and Stroke Statistics report, these findings have immediate relevance for clinical practice and patient care decisions.