Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries
Por:
Dobarro, D, Raposeiras-Roubin, S, Almenar-Bonet, L, Sole-Gonzalez, E, Padilla-Lopez, M, Diez-Lopez, C, Castrodeza, J, Garcia-Cosio, MD, Cobo-Marcos, M, Tobar, J, Codina, P, Lopez-Fernandez, S, Pastor, F, Rangel-Sousa, D, Barge-Caballero, E, Diaz-Molina, B, Barrio-Rodriguez, A, Burgos-Palacios, V, alvarez-Garcia, J, Gonzalez-Fernandez, O, Grau-Sepulveda, A, Garcia-Pinilla, JM, Ruiz-Bustillo, S, Mendez-Fernandez, AB, Vaqueriza-Cubillo, D, Sagasti-Aboitiz, I, Rodriguez-Santamarta, M, Lozano-Bahamonde, A, Abecia, A, Gomez-Otero, I, Marzoa, R, Gonzalez-Babarro, E, Gomez-Bueno, M, Gonzalez-Costello, J
Publicada:
1 dic 2024
Resumen:
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.
Filiaciones:
Dobarro, D:
Univ Vigo, Alvaro Cunqueiro Hosp, Galicia Sur Hlth Res Inst IIS Galicia Sur, Dept Anesthesiol, Vigo 36312, Spain
Raposeiras-Roubin, S:
Univ Vigo, Alvaro Cunqueiro Hosp, Galicia Sur Hlth Res Inst IIS Galicia Sur, Dept Anesthesiol, Vigo 36312, Spain
Almenar-Bonet, L:
Hosp Univ & Politecn La Fe, Cardiol Dept, Valencia, Spain
Sole-Gonzalez, E:
Hosp Clin I Prov, Dept Hematol, Barcelona 08036, Spain
Padilla-Lopez, M:
Hosp St Creu i St Pau, Pharm Dept, IIB St Pau, Barcelona 08025, Spain
Diez-Lopez, C:
Univ Barcelona, Hosp Universitari Bellvitge, Dept Dermatol, IDIBELL, Barcelona, Spain
Castrodeza, J:
Hosp Gen Univ Gregorio Maranon, Madrid 28007, Spain
Garcia-Cosio, MD:
Univ Madrid, Hosp 12 Octubre, Dept Pathol, Madrid 28041, Spain
Cobo-Marcos, M:
Hosp Univ Puerta Hierro Majadahonda, Med Oncol Dept, Madrid 28222, Spain
Tobar, J:
Hosp Clin Univ Valladolid, Valladolid 47003, Spain
Codina, P:
Hosp Germans Trias I Pujol, Neurosurg, Badalona, Spain
Lopez-Fernandez, S:
Hosp Univ Virgen Nieves, Dermatol Dept, Granada, Spain
Pastor, F:
Hosp Univ Virgen Arrixaca, Murcia 30120, Spain
Rangel-Sousa, D:
Univ Seville, Hosp Virgen Rocio, Serv Gastroenterol, Seville 41013, Spain
Barge-Caballero, E:
Complexo Hospitalario Univ A Coruna, Dept Urol, La Coruna, Spain
Diaz-Molina, B:
Hosp Univ Cent Asturias, Oviedo 33011, Spain
Barrio-Rodriguez, A:
Complejo Asistencial Univ Salamanca, Microbiol Serv, Salamanca 37007, Spain
Burgos-Palacios, V:
Hosp Univ Marques Valdecilla, Serv Nefrol, Santander 39008, Spain
alvarez-Garcia, J:
Hosp Univ Ramon y Cajal, CIBERCV, Madrid, Spain
Gonzalez-Fernandez, O:
Hosp Univ La Paz Madrid, Madrid, Spain
Grau-Sepulveda, A:
Hosp Univ Son Espases, Microbiol, Palma De Mallorca, Spain
Garcia-Pinilla, JM:
Virgen Victoria Univ Hosp, Malaga 29010, Spain
Ruiz-Bustillo, S:
Hosp Mar, Dept Rheumatol, Barcelona 08003, Spain
Mendez-Fernandez, AB:
Hosp Universitari Vall dHebron, Serv Neonatol, Barcelona, Spain
Vaqueriza-Cubillo, D:
Univ Hosp Infanta Leonor, Madrid, Spain
Sagasti-Aboitiz, I:
Hosp Univ Cruces, Baracaldo 48903, Bizkaia, Spain
Rodriguez-Santamarta, M:
Complejo Asistencial Univ Leon, Immunol Dept, Leon 24008, Spain
Lozano-Bahamonde, A:
Hosp Basurto, Bilbao 48013, Spain
Abecia, A:
Hosp Navarra, Pamplona 31008, Spain
Gomez-Otero, I:
Univ Santiago de Compostela, IGFAE, Santiago De Compostela 15706, Spain
Marzoa, R:
Hosp Arquitecto Marcide, Ferrol 15405, Spain
Gonzalez-Babarro, E:
Complejo Hosp Univ Pontevedra, Hosp Montecelo, Pontevedra, Spain
Gomez-Bueno, M:
Hosp Univ Puerta Hierro Majadahonda, Med Oncol Dept, Madrid 28222, Spain
Gonzalez-Costello, J:
Univ Barcelona, Hosp Universitari Bellvitge, Dept Dermatol, IDIBELL, Barcelona, Spain
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