Is there a role for subcutaneous furosemide in the community and hospice management of end-stage heart failure?

Abstract

Patients with advanced chronic heart failure (CHF) can experience 'revolving door' admissions, often for parenteral diuretics, when time at home is precious. Home intravenous diuretic services are patchy. This retrospective review describes 43 consecutive episodes of continuous subcutaneous infusion of furosemide (CSCI-F) in 32 advanced CHF patients; 28 episodes aiming to correct fluid balance and prevent hospital admission and 15 aiming to prevent symptoms in the dying. Overall, 26/28 (93%) avoided hospital admission. Weight loss occurred in 20/28 (70%): a median loss of 5.6 kg [interquartile range (IQR) 0.1-8.9]). The daily dose of furosemide ranged from 40 to 250 mg. The median number of days on CSCI-F was 10.5 (range 2-48; IQR 6-13.8). Site reactions occurred in 10/43 (23%); all of which were mild except two, one of which required oral antibiotics. Symptoms were controlled in all 15 dying patients. CSCI-F for patients with advanced CHF is effective in terms of weight loss and prevention of hospital admission with the heart failure nurse specialist playing a key overall management role in selection and monitoring. As the majority of community and hospice nurses have access to and are familiar with CSCI pumps, this practice should be nationally transferable. The role in the dying patient requires further assessment.

Dermatologic Adverse Effect of Subcutaneous Furosemide Administration in a Dog

“…9,10 Potential causes of the ulcer ative dermal lesions in the dog in this report include the following: (1) an immune-mediated reaction to furosemide; (2) mechanical tissue trauma from frequent injections; (3) chemical tissue irritation caused by 1 or more components of the furosemide solution; or (4) a combination of the aforementioned factors.…”

Dilemmas in the Dosing of Heart Failure Drugs: Titrating Diuretics in Chronic Heart Failure

“…[63][64][65] The sc2Wear TM Infusor, developed by scParmaceuticals TM (Burlington, MA, USA), is a small pump that attaches to the body via an adhesive and delivers subcutaneous injections of medications. It is currently being investigated for the administration of subcutaneous furosemide in patients admitted for acute decompensated heart failure.…”

Team-Based Care for Outpatients with Heart Failure

“…Safety of outpatient IV diuresis has been demonstrated, and in some study participants it decreased congestive symptoms, increased fluid weight loss, and improved NYHA class. [125][126][127][128][129] In addition, HF hospitalization was reduced. Ryder and colleagues 126 found that 72% of patients were stabilized and did not require hospitalization, 124 and Banerjee and colleagues 129 noted that 94% of patients were not admitted within 28 days following their outpatient IV diuresis regimen.…”

“…Ryder and colleagues 126 found that 72% of patients were stabilized and did not require hospitalization, 124 and Banerjee and colleagues 129 noted that 94% of patients were not admitted within 28 days following their outpatient IV diuresis regimen. [126][127][128] Unsurprisingly, considerable cost savings were noted when hospitalization was not required. 126,127,129 Further benefit was seen when outpatients receiving IV diuretics were linked with an HF disease management program.…”