Key result
Outpatient biweekly IV furosemide cuts 30-day ADHF rehospitalization by ~84% versus placebo.
Why the study?
Hospitalization for acute decompensated heart failure remains a major source of morbidity and mortality, prompting investigation into the feasibility, safety, and efficacy of outpatient intravenous furosemide infusion following discharge.
Does outpatient IV furosemide infusion reduce 30-day re-hospitalization in patients recently hospitalized for acute decompensated heart failure?
RCT (n=94)
Double-blind
1:1:1
No
Does outpatient IV furosemide infusion reduce 30-day re-hospitalization in patients recently hospitalized for acute decompensated heart failure?
Absolute Event Rate: 3.7% vs 22.6%
p-value: p=0.037
A standardized protocol of outpatient IV furosemide infusion for one month following ADHF hospitalization is safe and significantly reduces 30-day re-hospitalization compared to placebo.
Supports outpatient IV furosemide post-ADHF discharge to cut 30-day rehospitalization; extends RCT evidence for transitional diuretic strategies.
BACKGROUND: Hospitalization for acute decompensated heart failure (ADHF) remains a major source of morbidity and mortality. The current study aimed to investigate the feasibility, safety, and efficacy of outpatient furosemide intravenous (IV) infusion following hospitalization for ADHF. METHODS: In a single center, prospective, randomized, double-blind study, 100 patients were randomized to receive standard of care (Group 1), IV placebo infusion (Group 2), or IV furosemide infusion (Group 3) over 3h, biweekly for a one-month period following ADHF hospitalization. Patients in Groups 2/3 also received a comprehensive HF-care protocol including bi-weekly clinic visits for dose-adjusted IV-diuretics, medication adjustment and education. Echocardiography, quality of life and depression questionnaires were performed at baseline and 30-day follow-up. The primary outcome was 30-day re-hospitalization for ADHF. RESULTS: Overall, a total of 94 patients were included in the study (mean age 64 years, 56% males, 69% African American). There were a total of 14 (15%) hospitalizations for ADHF at 30 days, 6 (17.1%) in Group 1, 7 (22.6%) in Group 2, and 1 (3.7%) in Group 3 (overall p = 0.11; p = 0.037 comparing Groups 2 and 3). Patients receiving IV furosemide infusion experienced significantly greater urine output and weight loss compared to those receiving placebo without any significant increase creatinine and no significant between group differences in echocardiography parameters, KCCQ or depression scores. CONCLUSION: The use of a standardized protocol of outpatient IV furosemide infusion for a one-month period following hospitalization for ADHF was found to be safe and efficacious in reducing 30-day re-hospitalization.
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Hamo et al. (2021) conducted an RCT in Acute decompensated heart failure (n=94). Intravenous furosemide infusion vs. Intravenous placebo infusion or standard of care was evaluated on 30-day re-hospitalization for acute decompensated heart failure (p=0.037). Outpatient intravenous furosemide infusion biweekly for one month following hospitalization for acute decompensated heart failure significantly reduced 30-day re-hospitalization to 3.7% compared to 22.6% with placebo.
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