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

Ahmed, Fozia Z.; Taylor, Joanne K.; John, Anju V.; Khan, Muhammad A.; Zaidi, Amir M.; Mamas, Mamas A.; Motwani, Manish; Cunnington, Colin

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


Authors

Fozia Z. Ahmed

Joanne K. Taylor

Anju V. John

Muhammad A. Khan

Amir M. Zaidi

Manish Motwani

Colin Cunnington



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 RESULTS: We 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.

Journal Article Type Article
Acceptance Date Apr 1, 2021
Online Publication Date Aug 12, 2021
Publication Date 2021-10
Publicly Available Date Mar 29, 2024
Journal ESC Heart Failure
Print ISSN 2055-5822
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Volume 8
Issue 5
Pages 3906-3916
DOI https://doi.org/10.1002/ehf2.13368
Keywords Heart failure; Intravenous; Diuretics; Ambulatory; Elderly
Publisher URL https://doi.org/10.1002/ehf2.13368