DOME-HF 3 months: early outcomes of a diuretic day-hospital model for elderly patients with acute heart failure — a cardiogeriatric real-world experience

Heart failure (HF) remains a leading cause of hospitalisation and mortality among older adults. Conventional inpatient management exposes frail elderly patients to significant iatrogenic risks. A diuretic day-hospital (DH) model may offer a safe, efficient, and patient-centred alternative. The DOME-HF programme integrates cardiology and geriatrics to deliver IV diuretics in an outpatient setting. To describe the clinical and geriatric profile, organisation of care, and short-term (3-month) outcomes of elderly patients managed for acute HF through a dedicated DH pathway. This single-centre, retrospective observational study included all patients aged ≥ 65 years managed in the cardiogeriatric DH of Hôpital La Porte Verte (Versailles, France) between January and June 2025 for intravenous diuretic therapy. Sociodemographic, geriatric, and cardiologic characteristics, DH organisation, and 3-month outcomes were collected from medical records. Forty patients (mean age 88 ± 6.8 years; 47.5% female) were analysed. Most lived at home (95%) with preserved autonomy (ADL 5.4 ± 0.7). The mean Charlson Comorbidity Index was 8.9 ± 2.3; 92.5% had chronic kidney disease, 67.5% atrial fibrillation, and 55% ischaemic heart disease. Median NT-proBNP at DH discharge (end of the DH episode) was 3141.5 pg/mL [IQR 1066.8–5244.5]. The median delay from referral to first DH session was 1 day [IQR 0–3], with 2.2 ± 1.6 sessions per patient. At 3 months, 8 patients (20%) were readmitted for HF and 16 (40%) for any cause; HF-related and all-cause mortality were 2.5% and 7.5%, respectively. The DOME-HF model appears feasible and safe for very elderly, multimorbid patients with acute HF. It provides rapid access to outpatient IV diuretic therapy with structured monitoring and short-term follow-up. To our knowledge, this is the first French cardiogeriatric diuretic DH programme reporting early outcomes. Larger comparative studies are needed to determine its impact on rehospitalisation, hospital burden, and functional outcomes in frail older adults.