3779 Continuous subcutaneous infusion of furosemide for treatment of decompensated heart failure in frail older people in a hospital

Introduction Decompensated heart failure is a common acute presentation to hospital among the frail older population where treatment often involves intravenous furosemide. Whilst this is effective in inducing a diuresis, it can be associated with negative effects of hospital stay such as hospital-associated infections and deconditioning. Continuous subcutaneous infusion (CSCI) of furosemide is well-established as a palliative treatment for end-stage heart failure and there is growing evidence that CSCI Furosemide is as safe and effective as intravenous in the management of acute episodes of decompensation, whilst preventing hospital admission. This study retrospectively assesses the use and effectiveness of CSCI Furosemide for patients under York Virtual Frailty Ward. Methods 10 episodes of care using CSCI of furosemide were identified between November 2023 and May 2025. Included care episodes were those where patients received CSCI Furosemide, had a diagnosis of end stage heart failure and were housebound (CFS ≥6). All individuals received either 160 mg or 230 mg of CSCI Furosemide over a minimum treatment course of 48 hours. Patient records were reviewed to assess weight change and symptom burden pre- and post-CSCI Furosemide. Bed days saved by preventing hospital admission were calculated. Results The average weight loss through treatment was 0.83 kg/24 hours. All patients reported an improvement in symptom burden (oedema/mobility/breathing/fatigue). Two patients experienced a mild localised skin reaction, but treatment was able to continue safely with modifications. 40 bed days were found to have prevented through this community treatment. Conclusion This study demonstrates that CSCI is an effective treatment for management of decompensated heart failure of frail older individuals in the community. Although mild adverse effects may occur, they were short lived and did not prevent the treatment continuing. CSCI Furosemide offers benefits beyond its intended use including reducing risk of hospital-acquired harm and prevention of hospital bed days in an already strained system.