LVAD versus harttransplantatie bij hartfalen: Finse kosten en uitkomsten

AIMS: This real-world, retrospective study aimed to evaluate clinical outcomes and healthcare costs in advanced heart failure (HF) patients treated at Helsinki University Hospital with heart transplantation (HTx) or elective or urgent left ventricular assist device (LVAD) therapy over three years. METHODS AND RESULTS: Data were extracted from electronic medical records and validated through clinician review. Patients (n=78) were categorised into three groups: Group 1, HTx as first procedure, stratified into those without (1a, n=25) and with (1b, n=11) prior LVAD; Group 2, elective LVAD (n=30); and Group 3, urgent LVAD (n=12). Study endpoints included survival, six-minute walk test (6MWT) results, and healthcare costs at 3, 6, 12 and 24 months. Outcomes and costs were indirectly compared to explore their implications for future patient selection strategies.Survival exceeded 80% in groups 1 and 2. Group 1a had a 24-month survival rate of 84.0% (95% CI: 0.628-0.937), with most deaths (3 of 4) occurring within the first three months. Group 1b showed 100% survival throughout follow-up and group 2 stabilized at 93.4% (95% CI: 0.759-0.983) after two early deaths. Group 3 had progressive decline to 62.5% at 24 months (95% CI: 0.268-0.846). The confidence intervals between these groups overlap due to small sample size in group 3. Observed six-minute walking test (6MWT) performance improved steadily over the first year in all groups, with increases in distance walked and percentage of predicted values observed increasing between baseline and 12 months.Most healthcare expenses were concentrated within the first three months post-surgery. At 3 months, median costs per patient were €177,380 [IQR €121,900] (1a), €207,826 [IQR €83,398] (1b), €187,558 [IQR €67,664] (2), and €293,355 [IQR €67,664] (3). Group 3 incurred significantly higher costs compared to groups 1a (p=0.004) and 2 (p=0.003). While no significant difference was observed between group 3 and group 1b (p=0.335), difference was observed when group 1a and b were pooled. These trends were consistent at 6 months. The differences were no longer statistically significant at 12 and 24 months which may be due to wider cost variation or diminishing sample size. CONCLUSION: Elective LVAD in patients with advanced HF offers survival outcomes comparable to HTx and incurs similar costs and is preferable to urgent LVAD, which is associated with higher costs and may lead to poorer outcomes. These findings support more proactive patient selection and care pathway optimisation in advanced HF.