Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates
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: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:310164 |
| Acceso en línea: | https://ddd.uab.cat/record/310164 https://dx.doi.org/urn:doi:10.3390/life14121570 |
| Access Level: | acceso abierto |
| Palabra clave: | LVAD Advanced heart failure Inotropes |
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Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant CandidatesA Propensity Matching Analysis from the LEVO-D and REGALAD RegistriesDobarro, David|||0000-0003-0716-254XRaposeiras-Roubin, Sergio|||0000-0002-6462-4715Almenar Bonet, Luis|||0000-0002-7710-361XSolé González, Eduard|||0000-0002-5727-9925Padilla-Lopez, Mireia|||0000-0002-4374-3870Díez-López, Carles|||0000-0002-3734-4777Castrodeza, Javier|||0000-0002-4779-6849García-Cosío, María DoloresCobo-Marcos, M.|||0000-0002-9026-061XTobar, JavierCodina, Pau|||0000-0002-2469-5711Lopez-Fernandez, Silvia|||0000-0002-2461-8492Pastor, Francisco|||0000-0002-9818-2409Rangel Sousa, Diego|||0000-0003-2435-0155Barge-Caballero, EduardoDíaz-Molina, Beatriz|||0000-0002-7773-8121Barrio-Rodriguez, AlfredoBurgos-Palacios, VirginiaAlvarez-Garcia, Jesus|||0000-0002-2015-6446González-Fernández, Óscar|||0000-0003-3069-6101Grau-Sepulveda, AndrésGarcía Pinilla, José Manuel|||0000-0001-5999-5741Ruiz Bustillo, Sonia|||0000-0002-6074-914XMendez-Fernández, Ana B.Vaqueriza-Cubillo, David|||0000-0002-8207-7604Sagasti-Aboitiz, IgorRodriguez-Santamarta, MiguelLozano-Bahamonde, AinaraAbecia, AnaGómez-Otero, InésMarzoa, RaquelGonzález-Babarro, EvaGómez-Bueno, Manuel|||0000-0002-9764-7518González-Costello, José|||0000-0002-7437-3630LVADAdvanced heart failureInotropesHeart 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.Universitat Autònoma de Barcelona 22024-01-0120242024-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/310164https://dx.doi.org/urn:doi:10.3390/life14121570reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Aquest 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.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:3101642026-06-06T12:50:31Z |
| 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 |
| spellingShingle |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates Dobarro, David|||0000-0003-0716-254X LVAD Advanced heart failure Inotropes |
| title_short |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates |
| title_full |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates |
| title_fullStr |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates |
| title_full_unstemmed |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates |
| title_sort |
Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates |
| dc.creator.none.fl_str_mv |
Dobarro, David|||0000-0003-0716-254X Raposeiras-Roubin, Sergio|||0000-0002-6462-4715 Almenar Bonet, Luis|||0000-0002-7710-361X Solé González, Eduard|||0000-0002-5727-9925 Padilla-Lopez, Mireia|||0000-0002-4374-3870 Díez-López, Carles|||0000-0002-3734-4777 Castrodeza, Javier|||0000-0002-4779-6849 García-Cosío, María Dolores Cobo-Marcos, M.|||0000-0002-9026-061X Tobar, Javier Codina, Pau|||0000-0002-2469-5711 Lopez-Fernandez, Silvia|||0000-0002-2461-8492 Pastor, Francisco|||0000-0002-9818-2409 Rangel Sousa, Diego|||0000-0003-2435-0155 Barge-Caballero, Eduardo Díaz-Molina, Beatriz|||0000-0002-7773-8121 Barrio-Rodriguez, Alfredo Burgos-Palacios, Virginia Alvarez-Garcia, Jesus|||0000-0002-2015-6446 González-Fernández, Óscar|||0000-0003-3069-6101 Grau-Sepulveda, Andrés García Pinilla, José Manuel|||0000-0001-5999-5741 Ruiz Bustillo, Sonia|||0000-0002-6074-914X Mendez-Fernández, Ana B. Vaqueriza-Cubillo, David|||0000-0002-8207-7604 Sagasti-Aboitiz, Igor Rodriguez-Santamarta, Miguel Lozano-Bahamonde, Ainara Abecia, Ana Gómez-Otero, Inés Marzoa, Raquel González-Babarro, Eva Gómez-Bueno, Manuel|||0000-0002-9764-7518 González-Costello, José|||0000-0002-7437-3630 |
| author |
Dobarro, David|||0000-0003-0716-254X |
| author_facet |
Dobarro, David|||0000-0003-0716-254X Raposeiras-Roubin, Sergio|||0000-0002-6462-4715 Almenar Bonet, Luis|||0000-0002-7710-361X Solé González, Eduard|||0000-0002-5727-9925 Padilla-Lopez, Mireia|||0000-0002-4374-3870 Díez-López, Carles|||0000-0002-3734-4777 Castrodeza, Javier|||0000-0002-4779-6849 García-Cosío, María Dolores Cobo-Marcos, M.|||0000-0002-9026-061X Tobar, Javier Codina, Pau|||0000-0002-2469-5711 Lopez-Fernandez, Silvia|||0000-0002-2461-8492 Pastor, Francisco|||0000-0002-9818-2409 Rangel Sousa, Diego|||0000-0003-2435-0155 Barge-Caballero, Eduardo Díaz-Molina, Beatriz|||0000-0002-7773-8121 Barrio-Rodriguez, Alfredo Burgos-Palacios, Virginia Alvarez-Garcia, Jesus|||0000-0002-2015-6446 González-Fernández, Óscar|||0000-0003-3069-6101 Grau-Sepulveda, Andrés García Pinilla, José Manuel|||0000-0001-5999-5741 Ruiz Bustillo, Sonia|||0000-0002-6074-914X Mendez-Fernández, Ana B. Vaqueriza-Cubillo, David|||0000-0002-8207-7604 Sagasti-Aboitiz, Igor Rodriguez-Santamarta, Miguel Lozano-Bahamonde, Ainara Abecia, Ana Gómez-Otero, Inés Marzoa, Raquel González-Babarro, Eva Gómez-Bueno, Manuel|||0000-0002-9764-7518 González-Costello, José|||0000-0002-7437-3630 |
| author_role |
author |
| author2 |
Raposeiras-Roubin, Sergio|||0000-0002-6462-4715 Almenar Bonet, Luis|||0000-0002-7710-361X Solé González, Eduard|||0000-0002-5727-9925 Padilla-Lopez, Mireia|||0000-0002-4374-3870 Díez-López, Carles|||0000-0002-3734-4777 Castrodeza, Javier|||0000-0002-4779-6849 García-Cosío, María Dolores Cobo-Marcos, M.|||0000-0002-9026-061X Tobar, Javier Codina, Pau|||0000-0002-2469-5711 Lopez-Fernandez, Silvia|||0000-0002-2461-8492 Pastor, Francisco|||0000-0002-9818-2409 Rangel Sousa, Diego|||0000-0003-2435-0155 Barge-Caballero, Eduardo Díaz-Molina, Beatriz|||0000-0002-7773-8121 Barrio-Rodriguez, Alfredo Burgos-Palacios, Virginia Alvarez-Garcia, Jesus|||0000-0002-2015-6446 González-Fernández, Óscar|||0000-0003-3069-6101 Grau-Sepulveda, Andrés García Pinilla, José Manuel|||0000-0001-5999-5741 Ruiz Bustillo, Sonia|||0000-0002-6074-914X Mendez-Fernández, Ana B. Vaqueriza-Cubillo, David|||0000-0002-8207-7604 Sagasti-Aboitiz, Igor Rodriguez-Santamarta, Miguel Lozano-Bahamonde, Ainara Abecia, Ana Gómez-Otero, Inés Marzoa, Raquel González-Babarro, Eva Gómez-Bueno, Manuel|||0000-0002-9764-7518 González-Costello, José|||0000-0002-7437-3630 |
| 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 |
Universitat Autònoma de Barcelona |
| dc.subject.none.fl_str_mv |
LVAD Advanced heart failure Inotropes |
| topic |
LVAD Advanced heart failure Inotropes |
| 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 |
2 2024-01-01 2024 2024-01-01 |
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Article http://purl.org/coar/resource_type/c_6501 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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info:eu-repo/semantics/article |
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article |
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https://ddd.uab.cat/record/310164 https://dx.doi.org/urn:doi:10.3390/life14121570 |
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https://ddd.uab.cat/record/310164 https://dx.doi.org/urn:doi:10.3390/life14121570 |
| dc.language.none.fl_str_mv |
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 https://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 https://creativecommons.org/licenses/by/4.0/ |
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openAccess |
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