a8ed726e3f3c151bca6d39f7817c2cd5 310164.pdf abc71934bc767225af52868d93d9d242fcd3b41e 310164.pdf 1308af293b303e9f0c0ac72e0033e81447ad28716704a60036fb9a24218cea02 310164.pdf Title: Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries Subject: Heart transplantation (HT) is the gold standard therapy for advanced heart failure (ADHF), and LVADs as destination therapy are an option in non-HT candidates. Most patients with ADHF never receive HT or an LVAD, so alternative strategies are needed. Intermittent levosimendan can reduce HF hospitalizations in ADHF patients in the short term. It is uncertain whether the results of the comparison of inotropes with older-generation LVADs would have the same outcomes in the current era of ADHF patients treated with levosimendan, who are less sick but older. In this paper, we compare the use of two therapeutic strategies for end-stage HF in patients who are not candidates for HT: repetitive intermittent levosimendan vs. LVAD as destination therapy. To do so, we compare two multicenter cohorts of real-life patients from Spain: the LEVO-D registry and the REGALAD registry. In total, 715 patients coming from the two registries were found: 403 from LEVO-D and 312 from REGALAD. Non-adjusted median survival was shorter for LEVO-D patients, with the benefit for the LVADs seen only after the first year of therapy. The survival advantage for the LVAD cohort was also true after analysis of the matched cohort but, as in the non-matched analysis, the survival benefit was mainly shown after one year of follow-up. We conclude that in elderly ADHF non-HT candidates, LVAD therapy offers significantly better long-term outcomes when compared to intermittent levosimendan; thus, it should be considered in carefully selected candidates. On the other hand, in poor LVAD candidates or highly comorbid patients, intermittent inotropic support with levosimendan could be a reasonable alternative to LVAD, as 1-year outcomes are similar. Keywords: advanced heart failure; LVAD; inotropes Author: David Dobarro, Sergio Raposeiras-Roubin, Luis Almenar-Bonet, Eduard Solé-González, Mireia Padilla-Lopez, Carles Diez-Lopez, Javier Castrodeza, Maria Dolores García-Cosío, Marta Cobo-Marcos, Javier Tobar, Pau Codina, Silvia Lopez-Fernandez, Francisco Pastor, Diego Rangel-Sousa, Eduardo Barge-Caballero, Beatriz Diaz-Molina, Alfredo Barrio-Rodriguez, Virginia Burgos-Palacios, Jesús Álvarez-García, Oscar González-Fernández, Andrés Grau-Sepulveda, José Manuel Garcia-Pinilla, Sonia Ruiz-Bustillo, Ana B. Mendez-Fernández, David Vaqueriza-Cubillo, Igor Sagasti-Aboitiz, Miguel Rodriguez-Santamarta, Ainara Lozano-Bahamonde, Ana Abecia, Inés Gómez-Otero, Raquel Marzoa, Eva González-Babarro, Manuel Gómez-Bueno and José Gonzalez-Costello Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Fri Nov 29 12:34:02 2024 CET ModDate: Fri Nov 29 12:42:53 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 779855 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- WIRPUU+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 MNOPOF+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 UEJSER+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 KHDEYO+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 MFWPRN+VnURWPalladioL Type 1 Custom yes yes yes 32 0 JGMOZW+CMSY10 Type 1 Builtin yes yes yes 68 0 JPOCDB+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 76 0 JPOCDC+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 82 0 JPOCJB+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 88 0 JPOCJC+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 94 0 JPOCKC+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 97 0 JPOCKD+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 100 0 JPODAC+PalatinoLinotype-Roman TrueType MacRoman yes yes no 103 0 JPODLA+TimesNewRomanPSMT TrueType WinAnsi yes yes no 106 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 113 0 JPOCDB+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 127 0 JPOCDC+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 133 0 JPOCJB+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 139 0 JPOCJC+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 145 0 JPOCKC+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 148 0 JPOCKD+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 151 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-04-03 02:47:34 CEST RepresentationInformation: 310164.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-04-02 14:19:17 CEST Size: 779855 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 316 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Centers Involved Destination: subsection.2.1 Item: Title: LEVO-D Data Collection Destination: subsection.2.2 Item: Title: REGALAD Data Collection Destination: subsection.2.3 Item: Title: Endpoints Destination: subsection.2.4 Item: Title: Statistical Analysis Destination: subsection.2.5 Item: Title: Propensity Matching Destination: subsection.2.6 Item: Title: Results Destination: section.3 Children: Item: Title: Demographics Destination: subsection.3.1 Item: Title: Survival and HF Events Destination: subsection.3.2 Item: Title: Propensity Score Matching Destination: subsection.3.3 Item: Title: Discussion Destination: section.4 Children: Item: Title: Patients Characteristics of the Full Cohort Destination: subsection.4.1 Item: Title: Long- and Short-Term Outcomes Destination: subsection.4.2 Item: Title: Clinical Implications Destination: subsection.4.3 Item: Title: Limitations Destination: subsection.4.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries Author: David Dobarro, Sergio Raposeiras-Roubin, Luis Almenar-Bonet, Eduard Solé-González, Mireia Padilla-Lopez, Carles Diez-Lopez, Javier Castrodeza, Maria Dolores García-Cosío, Marta Cobo-Marcos, Javier Tobar, Pau Codina, Silvia Lopez-Fernandez, Francisco Pastor, Diego Rangel-Sousa, Eduardo Barge-Caballero, Beatriz Diaz-Molina, Alfredo Barrio-Rodriguez, Virginia Burgos-Palacios, Jesús Álvarez-García, Oscar González-Fernández, Andrés Grau-Sepulveda, José Manuel Garcia-Pinilla, Sonia Ruiz-Bustillo, Ana B. Mendez-Fernández, David Vaqueriza-Cubillo, Igor Sagasti-Aboitiz, Miguel Rodriguez-Santamarta, Ainara Lozano-Bahamonde, Ana Abecia, Inés Gómez-Otero, Raquel Marzoa, Eva González-Babarro, Manuel Gómez-Bueno and José Gonzalez-Costello Subject: Heart transplantation (HT) is the gold standard therapy for advanced heart failure (ADHF), and LVADs as destination therapy are an option in non-HT candidates. Most patients with ADHF never receive HT or an LVAD, so alternative strategies are needed. Intermittent levosimendan can reduce HF hospitalizations in ADHF patients in the short term. It is uncertain whether the results of the comparison of inotropes with older-generation LVADs would have the same outcomes in the current era of ADHF patients treated with levosimendan, who are less sick but older. In this paper, we compare the use of two therapeutic strategies for end-stage HF in patients who are not candidates for HT: repetitive intermittent levosimendan vs. LVAD as destination therapy. To do so, we compare two multicenter cohorts of real-life patients from Spain: the LEVO-D registry and the REGALAD registry. In total, 715 patients coming from the two registries were found: 403 from LEVO-D and 312 from REGALAD. Non-adjusted median survival was shorter for LEVO-D patients, with the benefit for the LVADs seen only after the first year of therapy. The survival advantage for the LVAD cohort was also true after analysis of the matched cohort but, as in the non-matched analysis, the survival benefit was mainly shown after one year of follow-up. We conclude that in elderly ADHF non-HT candidates, LVAD therapy offers significantly better long-term outcomes when compared to intermittent levosimendan; thus, it should be considered in carefully selected candidates. On the other hand, in poor LVAD candidates or highly comorbid patients, intermittent inotropic support with levosimendan could be a reasonable alternative to LVAD, as 1-year outcomes are similar. 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