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...

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Detalles Bibliográficos
Autores: Dobarro, David, Raposeiras Roubín, Sergio, Almenar Bonet, Luis, Solé González, Eduard, Padilla Lopez, Mireia, Diez Lopez, Carles, Castrodeza, Javier, García Cosío, María 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 Sepulveda, 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, González Costello, José
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/219588
Acceso en línea:https://hdl.handle.net/2445/219588
Access Level:acceso abierto
Palabra clave:Insuficiència cardíaca
Pròtesis
Heart failure
Prosthesis
Descripción
Sumario: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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