TY - JOUR
T1 - Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates
T2 - A Propensity Matching Analysis from the LEVO-D and REGALAD Registries
AU - Dobarro, David
AU - Raposeiras-Roubin, Sergio
AU - Almenar-Bonet, Luis
AU - Solé-González, Eduard
AU - Padilla-Lopez, Mireia
AU - Diez-Lopez, Carles
AU - Castrodeza, Javier
AU - García-Cosío, Maria Dolores
AU - Cobo-Marcos, Marta
AU - Tobar, Javier
AU - Codina, Pau
AU - Lopez-Fernandez, Silvia
AU - Pastor, Francisco
AU - Rangel-Sousa, Diego
AU - Barge-Caballero, Eduardo
AU - Diaz-Molina, Beatriz
AU - Barrio-Rodriguez, Alfredo
AU - Burgos-Palacios, Virginia
AU - Álvarez-García, Jesús
AU - González-Fernández, Oscar
AU - Grau-Sepulveda, Andrés
AU - Garcia-Pinilla, José Manuel
AU - Ruiz-Bustillo, Sonia
AU - Mendez-Fernández, Ana B.
AU - Vaqueriza-Cubillo, David
AU - Sagasti-Aboitiz, Igor
AU - Rodriguez-Santamarta, Miguel
AU - Lozano-Bahamonde, Ainara
AU - Abecia, Ana
AU - Gómez-Otero, Inés
AU - Marzoa, Raquel
AU - González-Babarro, Eva
AU - Gómez-Bueno, Manuel
AU - Gonzalez-Costello, José
N1 - Publisher Copyright:
© 2024 by the authors.
PY - 2024/12
Y1 - 2024/12
N2 - 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.
AB - 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.
KW - advanced heart failure
KW - inotropes
KW - LVAD
UR - http://www.scopus.com/inward/record.url?scp=85213323943&partnerID=8YFLogxK
U2 - 10.3390/life14121570
DO - 10.3390/life14121570
M3 - Article
AN - SCOPUS:85213323943
SN - 2075-1729
VL - 14
JO - Life
JF - Life
IS - 12
M1 - 1570
ER -