Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries

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-Perez; Diego Rangel-Sousa; Eduardo Barge-Caballero; Beatriz Diaz-Molina; Alfredo Barrio-Rodriguez; Virginia Burgos-Palacios; Jesús Álvarez-García; Oscar Gonzalez-Fernandez; 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

doi:10.20944/preprints202407.1516.v1

How to cite: Dobarro, D.; Raposeiras-Roubin, S.; Almenar-Bonet, L.; Solé-González, E.; Padilla-Lopez, M.; Diez-Lopez, C.; Castrodeza, J.; García-Cosío, M. D.; Cobo-Marcos, M.; Tobar, J.; Codina, P.; Lopez-Fernandez, S.; Pastor-Perez, F.; Rangel-Sousa, D.; Barge-Caballero, E.; Diaz-Molina, B.; Barrio-Rodriguez, A.; Burgos-Palacios, V.; Álvarez-García, J.; Gonzalez-Fernandez, O.; Grau-Sepulveda, A.; Garcia-Pinilla, J. M.; Ruiz-Bustillo, S.; Mendez-Fernández, A. B.; Vaqueriza-Cubillo, D.; Sagasti-Aboitiz, I.; Rodriguez-Santamarta, M.; Lozano-Bahamonde, A.; Abecia, A.; Gómez-Otero, I.; Marzoa, R.; González-Babarro, E.; Gómez-Bueno, M.; Gonzalez-Costello, J. Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries. Preprints 2024, 2024071516. https://doi.org/10.20944/preprints202407.1516.v1 Dobarro, D.; Raposeiras-Roubin, S.; Almenar-Bonet, L.; Solé-González, E.; Padilla-Lopez, M.; Diez-Lopez, C.; Castrodeza, J.; García-Cosío, M. D.; Cobo-Marcos, M.; Tobar, J.; Codina, P.; Lopez-Fernandez, S.; Pastor-Perez, F.; Rangel-Sousa, D.; Barge-Caballero, E.; Diaz-Molina, B.; Barrio-Rodriguez, A.; Burgos-Palacios, V.; Álvarez-García, J.; Gonzalez-Fernandez, O.; Grau-Sepulveda, A.; Garcia-Pinilla, J. M.; Ruiz-Bustillo, S.; Mendez-Fernández, A. B.; Vaqueriza-Cubillo, D.; Sagasti-Aboitiz, I.; Rodriguez-Santamarta, M.; Lozano-Bahamonde, A.; Abecia, A.; Gómez-Otero, I.; Marzoa, R.; González-Babarro, E.; Gómez-Bueno, M.; Gonzalez-Costello, J. Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries. Preprints 2024, 2024071516. https://doi.org/10.20944/preprints202407.1516.v1

Abstract

Heart transplantation (HT) is the gold standard therapy for advanced heart failure (AHF) and LVAD as destination therapy are an option in non-HT candidates. Most patients with AHF never receive a HT or a LVAD, so alternative strategies are needed. Intermittent levosimendan can reduce HF hospitalizations in AHF patients in the short term. It is uncertain whether the results of the comparison of inotropes with older generation LVAD would have the same outcomes in the current era of less sick but older, AHF treated with levosimendan patients. In this paper we compare the use of two therapeutic strategies for end-stage HF in patients not candidates for HT: Repetitive intermittent Levosimendan vs. LVAD as destination therapy. To do so we compare two multicentre cohorts of real-life patients from Spain: the LEVO-D Registry and the REGALAD registry. 715 patients coming from the 2 registries where found, 403 from the LEVO-D and 312 from the REGALAD. Non-adjusted median survival was shorter for LEVO-D patients; with the benefit for the LVAD 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 AHF 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, intermit-tent inotropic support with levosimendan could be a reasonable alternative to LVAD as 1-year outcomes are similar.

Keywords

Subject

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Not displayed online.

Please leave your comment to this article below.

Mathematical equations can be typed in either LaTeX formats \\[ ... \\] or $$ ... $$, or MathML format <math> ... </math>. Try the LaTeX or MathML example.

Type equation:

Preview:

Copy equation into message below

Close menu

Please click a symbol to insert it into the message box below:

Please enter the link here:

Optionally, you can enter text that should appear as linked text:

Copy link into message below

Please enter or paste the URL to the image here (please only use links to jpg/jpeg, png and gif images):

Copy image into message below

Type author name or keywords to filter the list of references in this group (you can add a new citation under Bibliography):

No existing citations in Discussion Group

Wikify editor is a simple editor for wiki-style mark-up. It was written by MDPI for Sciforum in 2014. The rendering of the mark-up is based on Wiky.php with some tweaks. Rendering of mathematical equations is done with MathJax. Please send us a message for support or for reporting bugs.

Please declare any conflicts of interest you may have with this paper, financial or otherwise.

I do not have a conflict of interest

I would like to declare a conflict of interest

Display my name on the website

Captcha

Renew

I accept the following conditions:

Comments must follow the standards of professional discourse and should focus on the scientific content of the article. Insulting or offensive language, personal attacks and off-topic remarks will not be permitted. Comments must be written in English. Preprints reserves the right to remove comments without notice. Readers who post comments are obliged to declare any competing interests, financial or otherwise.

Destination Therapy Strategies of Advanced Heart Failure in Elderly Non-Heart Transplant Candidates: A Propensity Matching Analysis from the LEVO-D and REGALAD Registries

Abstract

Keywords

Subject

Comments (0)