Ambulatory intravenous furosemide for decompensated heart failure: safe, feasible, and effective

Abstract

Aims This study aims to establish the feasibility, safety, and efficacy of outpatient intravenous (IV) diuretic treatment for the management of decompensated heart failure (HF) for patients enrolled in the HeartFailure@Home service. Methods and resultsWe retrospectively analysed the clinical episodes of decompensated HF for patients enrolled in the HeartFailure@Home service, managed by ambulatory IV diuretic treatment either at home or on a day-case unit. A control group consisting of HF patients admitted to hospital for IV diuretics (standard-of-care) was also evaluated. In total, 203 episodes of decompensated HF (n = 154 patients) were evaluated. One hundred and fourteen episodes in 79 patients were managed exclusively by the ambulatory IV diuretic service-78 (68.4%) on a day-case unit and 36 (31.6%) domiciliary; 84.1% of patient episodes under the HF@Home service were successfully managed entirely in an out-patient setting without hospitalization. Eleven patients required admission in order to administer higher doses of IV diuretics than could be provided in the ambulatory setting. During follow-up, there were 20 (17.5%) 30 day re-admissions with HF or death in the ambulatory IV group and 29 (32.6%) in the standard-of-care arm (P = 0.02). There was no difference in 30 day HF readmissions between the two groups (14.9% ambulatory vs. 13.5% inpatients, P = 0.8), but 30 day mortality was significantly lower in the ambulatory group (3.5% vs. 21.3% inpatients, P < 0.001). Conclusions Outpatient ambulatory management of decompensated HF with IV diuretics given either on a day case unit or in a domiciliary setting is feasible, safe, and effective in selected patients with decompensated HF. This should be explored further as a model in delivering HF services in the outpatient setting during COVID-19.

Outpatient intravenous diuresis in a rural setting: safety, efficacy, and outcomes

“…Most of these clinics did not compare their results to inpatient groups, making it difficult to determine the effectiveness of outpatient IV diuresis in reducing mortality rates. These conflicting findings highlight the necessity for further research ( 8 , 16 ).…”

“…One strategy to augment HF care and reduce readmission costs is the implementation of outpatient intravenous (OP IV) diuresis to address decompensated HF in outpatient clinics, infusion centers, and more recently, home-based IV diuresis care. While preliminary studies have demonstrated promising results in urban settings, additional research is necessary to assess the efficacy in rural communities (3)(4)(5)(6)(7)(8)(9)(10).…”

Practical outpatient management of worsening chronic heart failure

“…We propose an approach to the use of IV diuretics in an ambulatory setting (Figure 3) along with factors to be considered to select eligible patients (Table 2). [58][59][60][61][62][63]…”

A new tool to measure acuity in the community: a case study

“…Fluid overload is a commonly seen symptom of decompensated chronic heart failure. In the last 10 years, there has been a growing evidence base to demonstrate the likely benefits of intravenous diuretic management in the patient's own home (Ahmed et al, 2021, Halatchev et al, 2021.…”