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 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.
Authors
- Diego Rangel‐Sousa (ORCID: https://orcid.org/0000-0003-2435-0155)
- Jesús Álvarez‐García (ORCID: https://orcid.org/0000-0002-2015-6446)
- Marta Cobo Marcos (ORCID: https://orcid.org/0000-0002-9026-061X)
- José González‐Costello (ORCID: https://orcid.org/0000-0002-7437-3630)
- María Dolores García‐Cosío Carmena (ORCID: https://orcid.org/0000-0002-9330-9896)
- Francisco J. Pastor‐Pérez (ORCID: https://orcid.org/0000-0002-9818-2409)
- Eva González‐Babarro
- Andrés Grau-Sepulveda
- Ana Abecia
- Eduardo Barge‐Caballero (ORCID: https://orcid.org/0000-0002-2572-2048)
- Eduard Solé‐González (ORCID: https://orcid.org/0000-0002-5727-9925)
- José Manuel García‐Pinilla (ORCID: https://orcid.org/0000-0001-5999-5741)
- Sonia Ruiz (ORCID: https://orcid.org/0000-0002-6074-914X)
- Sergio Raposeiras‐Roubín (ORCID: https://orcid.org/0000-0002-6462-4715)
- Raquel Marzoa
- Silvia López‐Fernández (ORCID: https://orcid.org/0000-0002-2461-8492)
- Manuel Gómez‐Bueno (ORCID: https://orcid.org/0000-0002-9764-7518)
- Luis Almenar‐Bonet (ORCID: https://orcid.org/0000-0002-7710-361X)
- Beatriz Díaz‐Molina (ORCID: https://orcid.org/0000-0002-7773-8121)
- Óscar González Fernández (ORCID: https://orcid.org/0000-0003-3069-6101)
- David Vaqueriza Cubillo (ORCID: https://orcid.org/0000-0002-8207-7604)
- Virginia Burgos-Palacios
- Pau Codina (ORCID: https://orcid.org/0000-0002-2469-5711)
- Inés Gómez‐Otero (ORCID: https://orcid.org/0000-0001-6278-2464)
- Alfredo Barrio-Rodríguez
- Miguel Rodríguez-Santamarta (ORCID: https://orcid.org/0000-0002-2244-1259)
- Carles Díez‐López (ORCID: https://orcid.org/0000-0002-3734-4777)
- Ainara Lozano Bahamonde (ORCID: https://orcid.org/0000-0002-9362-4116)
- Mireia Padilla-Lopez
- Igor Sagasti‐Aboitiz
- David Dobarro (ORCID: https://orcid.org/0000-0003-0716-254X)
- Javier Castrodeza (ORCID: https://orcid.org/0000-0002-4779-6849)
- Javier Tobar
- Ana B. Mendez-Fernández
Institutions
- Hospital Universitario La Paz (ES)
- Hospital de Sant Pau (ES)
- Bellvitge University Hospital (ES)
- University Hospital Complex Of Vigo (ES)
- Hospital General Universitario Gregorio Marañón (ES)
- Institut d'Investigació Biomédica de Bellvitge (ES)
- Hospital de Basurto (ES)
- Centro de Investigación en Red en Enfermedades Cardiovasculares (ES)
- Complejo Hospitalario Universitario de Santiago (ES)
- Complejo Hospitalario de Salamanca (ES)
- Marqués de Valdecilla University Hospital (ES)
- Hospital Universitario Puerta de Hierro Majadahonda (ES)
- Centro de Investigación Biomédica en Red (ES)
- Hospital Clínic de Barcelona (ES)
- Hospital Universitario Virgen de las Nieves (ES)
- Vall d'Hebron Hospital Universitari (ES)
- Hospital Del Mar (ES)
- Hospital Universitario Central de Asturias (ES)
- Hospital de Cruces (ES)
- Complexo Hospitalario Universitario A Coruña (ES)
- Hospital Universitario Virgen de la Arrixaca (ES)
- Hospital Universitario Son Espases (ES)
- Hospital Universitario Virgen del Rocío (ES)
- Hospital Universitari Germans Trias i Pujol (ES)
- Hospital Clínico Universitario Virgen de la Victoria (ES)
- Hospital Clínico Universitario de Valladolid (ES)
- Hospital Universitario de León (ES)
- Hospital Universitario Ramón y Cajal (ES)
- Hospital Montecelo (ES)
- Instituto de Investigación Biomédica de Málaga (ES)
- Hospital Universitario Infanta Leonor (ES)
- Complejo Hospitalario Universitario de Ferrol (ES)
- Universitat de Barcelona (ES)
- Universidad de Navarra (ES)
Publication Details
- Journal
- Life
- Published
- 2024-11-29
- DOI
- https://doi.org/10.3390/life14121570
- Citations
- 2
- Primary Topic
- Mechanical Circulatory Support Devices
- Type
- article
- Field-Weighted Citation Impact
- 0.37