Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates : A Propensity Matching Analysis from the LEVO-D and REGALAD Registries
Dobarro, David (Hospital Álvaro Cunqueiro (Vigo))
Raposeiras-Roubin, Sergio (Hospital Álvaro Cunqueiro (Vigo))
Almenar Bonet, Luis (Hospital Universitari i Politècnic La Fe (València))
Solé González, Eduard (Hospital Clínic i Provincial de Barcelona)
Padilla-Lopez, Mireia (Institut de Recerca Sant Pau)
Díez-López, Carles (Hospital Universitari de Bellvitge)
Castrodeza, Javier (Hospital General Universitario Gregorio Marañón)
García-Cosío, María Dolores (Hospital 12 de Octubre (Madrid))
Cobo-Marcos, M. (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Tobar, Javier (Hospital Clínico Universitario de Valladolid)
Codina, Pau (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Lopez-Fernandez, Silvia (Hospital Universitario Virgen de las Nieves (Granada))
Pastor, Francisco (Hospital Universitario Virgen de la Arrixaca (Múrcia))
Rangel Sousa, Diego (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Barge-Caballero, Eduardo (Complejo Hospitalario Universitario de A Coruña)
Díaz-Molina, Beatriz (Hospital Universitario Central de Asturias)
Barrio-Rodriguez, Alfredo (Complejo Asistencial de Salamanca)
Burgos-Palacios, Virginia (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Álvarez-García, Jesús (Hospital Universitario Ramón y Cajal (Madrid))
González-Fernández, Óscar (Hospital Universitario La Paz (Madrid))
Grau-Sepulveda, Andrés (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
García-Pinilla, José Manuel (Instituto de Investigación Biomédica de Málaga)
Ruiz Bustillo, Sonia (Hospital del Mar (Barcelona, Catalunya))
Mendez-Fernández, Ana B. (Hospital Universitari Vall d'Hebron)
Vaqueriza-Cubillo, David (Hospital Universitario Infanta Leonor)
Sagasti-Aboitiz, Igor (Hospital Universitario de Cruces (Barakaldo, País Basc))
Rodriguez-Santamarta, Miguel (Complejo Hospitalario Universitario de León)
Lozano-Bahamonde, Ainara (Hospital Universitario de Basurto (Bilbao, Biscaia))
Abecia, Ana (Complejo Hospitalario de Navarra)
Gómez-Otero, Inés (Complexo Hospitalario Universitario de Santiago)
Marzoa, Raquel (Hospital Arquitecto Marcide)
González-Babarro, Eva (Hospital de Montecelo)
Gómez-Bueno, Manuel (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
González-Costello, José (Hospital Universitari de Bellvitge)
Universitat Autònoma de Barcelona

Date:	2024
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	LVAD ; Advanced heart failure ; Inotropes
Published in:	Life, Vol. 14 Núm. 12 (december 2024) , p. 1570, ISSN 2075-1729

DOI: 10.3390/life14121570
PMID: 39768278

13 p, 761.6 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles