Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries
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 hospitali...
| Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Conselleria de Salut i Consum del Govern de les Illes Balears |
| Repositorio: | Docusalut |
| Idioma: | inglés |
| OAI Identifier: | oai:docusalut.com:20.500.13003/21686 |
| Acceso en línea: | https://hdl.handle.net/20.500.13003/21686 |
| Access Level: | acceso abierto |
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Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD RegistriesDobarro, DavidRaposeiras-Roubin, SergioAlmenar-Bonet, LuisSolé-González, EduardPadilla-Lopez, MireiaDiez-Lopez, CarlesCastrodeza, JavierGarcía-Cosío, Maria DoloresCobo-Marcos, MartaTobar, JavierCodina, PauLopez-Fernandez, SilviaPastor, FranciscoRangel-Sousa, DiegoBarge-Caballero, EduardoDiaz-Molina, BeatrizBarrio-Rodriguez, AlfredoBurgos-Palacios, VirginiaÁlvarez-García, JesúsGonzález-Fernández, OscarGrau-Sepúlveda, AndrésGarcia-Pinilla, José ManuelRuiz-Bustillo, SoniaMendez-Fernández, Ana BVaqueriza-Cubillo, DavidSagasti-Aboitiz, IgorRodriguez-Santamarta, MiguelLozano-Bahamonde, AinaraAbecia, AnaGómez-Otero, InésMarzoa, RaquelGonzález-Babarro, EvaGómez-Bueno, ManuelGonzalez-Costello, JoséHeart 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.MDPI20242024-11-2920242024-11-29research articlehttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.13003/21686reponame:Docusalutinstname:Conselleria de Salut i Consum del Govern de les Illes BalearsInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Atribución 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:docusalut.com:20.500.13003/216862026-06-22T12:44:07Z |
| dc.title.none.fl_str_mv |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries |
| 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 |
| spellingShingle |
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 |
| title_short |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries |
| title_full |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries |
| title_fullStr |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries |
| title_full_unstemmed |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries |
| title_sort |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries |
| dc.creator.none.fl_str_mv |
Dobarro, David Raposeiras-Roubin, Sergio Almenar-Bonet, Luis Solé-González, Eduard Padilla-Lopez, Mireia Diez-Lopez, Carles Castrodeza, Javier García-Cosío, Maria Dolores Cobo-Marcos, Marta Tobar, Javier Codina, Pau Lopez-Fernandez, Silvia Pastor, Francisco Rangel-Sousa, Diego Barge-Caballero, Eduardo Diaz-Molina, Beatriz Barrio-Rodriguez, Alfredo Burgos-Palacios, Virginia Álvarez-García, Jesús González-Fernández, Oscar Grau-Sepúlveda, Andrés Garcia-Pinilla, José Manuel Ruiz-Bustillo, Sonia Mendez-Fernández, Ana B Vaqueriza-Cubillo, David Sagasti-Aboitiz, Igor Rodriguez-Santamarta, Miguel Lozano-Bahamonde, Ainara Abecia, Ana Gómez-Otero, Inés Marzoa, Raquel González-Babarro, Eva Gómez-Bueno, Manuel Gonzalez-Costello, José |
| author |
Dobarro, David |
| author_facet |
Dobarro, David Raposeiras-Roubin, Sergio Almenar-Bonet, Luis Solé-González, Eduard Padilla-Lopez, Mireia Diez-Lopez, Carles Castrodeza, Javier García-Cosío, Maria Dolores Cobo-Marcos, Marta Tobar, Javier Codina, Pau Lopez-Fernandez, Silvia Pastor, Francisco Rangel-Sousa, Diego Barge-Caballero, Eduardo Diaz-Molina, Beatriz Barrio-Rodriguez, Alfredo Burgos-Palacios, Virginia Álvarez-García, Jesús González-Fernández, Oscar Grau-Sepúlveda, Andrés Garcia-Pinilla, José Manuel Ruiz-Bustillo, Sonia Mendez-Fernández, Ana B Vaqueriza-Cubillo, David Sagasti-Aboitiz, Igor Rodriguez-Santamarta, Miguel Lozano-Bahamonde, Ainara Abecia, Ana Gómez-Otero, Inés Marzoa, Raquel González-Babarro, Eva Gómez-Bueno, Manuel Gonzalez-Costello, José |
| author_role |
author |
| author2 |
Raposeiras-Roubin, Sergio Almenar-Bonet, Luis Solé-González, Eduard Padilla-Lopez, Mireia Diez-Lopez, Carles Castrodeza, Javier García-Cosío, Maria Dolores Cobo-Marcos, Marta Tobar, Javier Codina, Pau Lopez-Fernandez, Silvia Pastor, Francisco Rangel-Sousa, Diego Barge-Caballero, Eduardo Diaz-Molina, Beatriz Barrio-Rodriguez, Alfredo Burgos-Palacios, Virginia Álvarez-García, Jesús González-Fernández, Oscar Grau-Sepúlveda, Andrés Garcia-Pinilla, José Manuel Ruiz-Bustillo, Sonia Mendez-Fernández, Ana B Vaqueriza-Cubillo, David Sagasti-Aboitiz, Igor Rodriguez-Santamarta, Miguel Lozano-Bahamonde, Ainara Abecia, Ana Gómez-Otero, Inés Marzoa, Raquel González-Babarro, Eva Gómez-Bueno, Manuel Gonzalez-Costello, José |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
|
| description |
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. |
| publishDate |
2024 |
| dc.date.none.fl_str_mv |
2024 2024-11-29 2024 2024-11-29 |
| dc.type.none.fl_str_mv |
research article http://purl.org/coar/resource_type/c_2df8fbb1 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
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article |
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https://hdl.handle.net/20.500.13003/21686 |
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https://hdl.handle.net/20.500.13003/21686 |
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Inglés eng |
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Inglés |
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eng |
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open access http://purl.org/coar/access_right/c_abf2 Atribución 4.0 Internacional http://creativecommons.org/licenses/by/4.0/ |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 Atribución 4.0 Internacional http://creativecommons.org/licenses/by/4.0/ |
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openAccess |
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application/pdf |
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MDPI |
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MDPI |
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reponame:Docusalut instname:Conselleria de Salut i Consum del Govern de les Illes Balears |
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