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...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-11-01
|
| Series: | Life |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-1729/14/12/1570 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850036232802795520 |
|---|---|
| author | David Dobarro Sergio Raposeiras-Roubin Luis Almenar-Bonet Eduard Solé-González Mireia Padilla-Lopez Carles Diez-Lopez Javier Castrodeza Maria Dolores García-Cosío Marta Cobo-Marcos Javier Tobar Pau Codina Silvia Lopez-Fernandez Francisco Pastor Diego Rangel-Sousa Eduardo Barge-Caballero Beatriz Diaz-Molina Alfredo Barrio-Rodriguez Virginia Burgos-Palacios Jesús Álvarez-García Oscar González-Fernández Andrés Grau-Sepulveda José Manuel Garcia-Pinilla Sonia Ruiz-Bustillo Ana B. Mendez-Fernández David Vaqueriza-Cubillo Igor Sagasti-Aboitiz Miguel Rodriguez-Santamarta Ainara Lozano-Bahamonde Ana Abecia Inés Gómez-Otero Raquel Marzoa Eva González-Babarro Manuel Gómez-Bueno José Gonzalez-Costello |
| author_facet | David Dobarro Sergio Raposeiras-Roubin Luis Almenar-Bonet Eduard Solé-González Mireia Padilla-Lopez Carles Diez-Lopez Javier Castrodeza Maria Dolores García-Cosío Marta Cobo-Marcos Javier Tobar Pau Codina Silvia Lopez-Fernandez Francisco Pastor Diego Rangel-Sousa Eduardo Barge-Caballero Beatriz Diaz-Molina Alfredo Barrio-Rodriguez Virginia Burgos-Palacios Jesús Álvarez-García Oscar González-Fernández Andrés Grau-Sepulveda José Manuel Garcia-Pinilla Sonia Ruiz-Bustillo Ana B. Mendez-Fernández David Vaqueriza-Cubillo Igor Sagasti-Aboitiz Miguel Rodriguez-Santamarta Ainara Lozano-Bahamonde Ana Abecia Inés Gómez-Otero Raquel Marzoa Eva González-Babarro Manuel Gómez-Bueno José Gonzalez-Costello |
| author_sort | David Dobarro |
| collection | DOAJ |
| 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. |
| format | Article |
| id | doaj-art-919bea82641d428b91f482ec37c45ea8 |
| institution | DOAJ |
| issn | 2075-1729 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Life |
| spelling | doaj-art-919bea82641d428b91f482ec37c45ea82025-08-20T02:57:14ZengMDPI AGLife2075-17292024-11-011412157010.3390/life14121570Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD RegistriesDavid Dobarro0Sergio Raposeiras-Roubin1Luis Almenar-Bonet2Eduard Solé-González3Mireia Padilla-Lopez4Carles Diez-Lopez5Javier Castrodeza6Maria Dolores García-Cosío7Marta Cobo-Marcos8Javier Tobar9Pau Codina10Silvia Lopez-Fernandez11Francisco Pastor12Diego Rangel-Sousa13Eduardo Barge-Caballero14Beatriz Diaz-Molina15Alfredo Barrio-Rodriguez16Virginia Burgos-Palacios17Jesús Álvarez-García18Oscar González-Fernández19Andrés Grau-Sepulveda20José Manuel Garcia-Pinilla21Sonia Ruiz-Bustillo22Ana B. Mendez-Fernández23David Vaqueriza-Cubillo24Igor Sagasti-Aboitiz25Miguel Rodriguez-Santamarta26Ainara Lozano-Bahamonde27Ana Abecia28Inés Gómez-Otero29Raquel Marzoa30Eva González-Babarro31Manuel Gómez-Bueno32José Gonzalez-Costello33Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, IIS Galicia Sur, 36312 Vigo, SpainHospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, IIS Galicia Sur, 36312 Vigo, SpainHospital Universitario La Fe, CIBERCV, 46126 Valencia, SpainHospital Clinic i Provincial, 08036 Barcelona, SpainHospital de la Santa Creu i Sant Pau, IIB SANT PAU, 08025 Barcelona, SpainHospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, CIBER-CV, Hospitalet del Llobregat, 08007 Barcelona, SpainHospital General Universitario Gregorio Marañón, 28007 Madrid, SpainHospital 12 de Octubre Madrid, IMAS12, CIBERCV, 28041 Madrid, SpainHospital Universitario Puerta de Hierro, IDIPHISA, 28222 Madrid, SpainHospital Clínico Universitario de Valladolid, 47003 Valladolid, SpainHospital Germans Trias i Pujol, 08916 Badalona, SpainHospital Universitario Virgen de las Nieves, IBSGranada, 18016 Granada, SpainHospital Universitario Virgen de la Arrixaca, 30120 Murcia, SpainHospital Universitario Virgen del Rocio, 41013 Sevilla, SpainComplexo Hospitalario Universitario de A Coruña, CIBERCV, 15006 A Coruña, SpainHospital Universitario Central de Asturias, 33011 Oviedo, SpainComplejo Asistencial de Salamanca, 37007 Salamanca, SpainHospital Universitario Marqués de Valdecilla, 39008 Santander, SpainHospital Universitario Ramón y Cajal, CIBERCV, 28034 Madrid, SpainHospital Universitario La Paz, 28046 Madrid, SpainHospital Universitario Son Espases, 07120 Palma de Mallorca, SpainHospital Universitario Virgen de la Victoria, IBIMA, 29010 Malaga, SpainHospital del Mar, 08003 Barcelona, SpainHospital Universitari Vall d’Hebron, 08035 Barcelona, SpainHospital Universitario Infanta Leonor, 28040 Madrid, SpainHospital Universitario de Cruces, 48903 Bizkaia, SpainComplejo Hospitalario Universitario de León, 24008 León, SpainHospital de Basurto, 48013 Bilbao, SpainHospital de Navarra, 31008 Pamplona, SpainComplexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, SpainHospital Arquitecto Marcide, 15405 Ferrol, SpainHospital de Montecelo, Complexo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, SpainHospital Universitario Puerta de Hierro, IDIPHISA, 28222 Madrid, SpainHospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, CIBER-CV, Hospitalet del Llobregat, 08007 Barcelona, SpainHeart 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.https://www.mdpi.com/2075-1729/14/12/1570advanced heart failureLVADinotropes |
| spellingShingle | David Dobarro Sergio Raposeiras-Roubin Luis Almenar-Bonet Eduard Solé-González Mireia Padilla-Lopez Carles Diez-Lopez Javier Castrodeza Maria Dolores García-Cosío Marta Cobo-Marcos Javier Tobar Pau Codina Silvia Lopez-Fernandez Francisco Pastor Diego Rangel-Sousa Eduardo Barge-Caballero Beatriz Diaz-Molina Alfredo Barrio-Rodriguez Virginia Burgos-Palacios Jesús Álvarez-García Oscar González-Fernández Andrés Grau-Sepulveda José Manuel Garcia-Pinilla Sonia Ruiz-Bustillo Ana B. Mendez-Fernández David Vaqueriza-Cubillo Igor Sagasti-Aboitiz Miguel Rodriguez-Santamarta Ainara Lozano-Bahamonde Ana Abecia Inés Gómez-Otero Raquel Marzoa Eva González-Babarro Manuel Gómez-Bueno José Gonzalez-Costello Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries Life advanced heart failure LVAD inotropes |
| 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 |
| 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_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_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 |
| topic | advanced heart failure LVAD inotropes |
| url | https://www.mdpi.com/2075-1729/14/12/1570 |
| work_keys_str_mv | AT daviddobarro destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT sergioraposeirasroubin destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT luisalmenarbonet destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT eduardsolegonzalez destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT mireiapadillalopez destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT carlesdiezlopez destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT javiercastrodeza destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT mariadoloresgarciacosio destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT martacobomarcos destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT javiertobar destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT paucodina destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT silvialopezfernandez destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT franciscopastor destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT diegorangelsousa destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT eduardobargecaballero destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT beatrizdiazmolina destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT alfredobarriorodriguez destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT virginiaburgospalacios destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT jesusalvarezgarcia destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT oscargonzalezfernandez destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT andresgrausepulveda destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT josemanuelgarciapinilla destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT soniaruizbustillo destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT anabmendezfernandez destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT davidvaquerizacubillo destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT igorsagastiaboitiz destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT miguelrodriguezsantamarta destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT ainaralozanobahamonde destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT anaabecia destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT inesgomezotero destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT raquelmarzoa destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT evagonzalezbabarro destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT manuelgomezbueno destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries AT josegonzalezcostello destinationtherapystrategiesofadvancedheartfailureinelderlynonhearttransplantcandidatesapropensitymatchinganalysisfromthelevodandregaladregistries |