Ambulatory intravenous diuretic treatment for decompensated heart failure significantly reduced 30-day HF readmission or death compared to standard inpatient care (17.5% vs 32.6%, P=0.02).
Observational (n=154)
Does ambulatory intravenous furosemide reduce 30-day mortality or readmissions compared to inpatient intravenous diuretics in patients with decompensated heart failure?
Ambulatory management of decompensated heart failure with IV diuretics is feasible and associated with lower 30-day mortality compared to standard inpatient care, offering a potential alternative to hospitalization.
Absolute Event Rate: 17.5% vs 32.6%
p-value: p=0.02
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.
Ahmed et al. (Thu,) conducted a observational in Decompensated heart failure (n=154). Ambulatory intravenous (IV) diuretic treatment vs. Hospital admission for IV diuretics (standard-of-care) was evaluated on 30 day re-admissions with HF or death (p=0.02). Ambulatory intravenous diuretic treatment for decompensated heart failure significantly reduced 30-day HF readmission or death compared to standard inpatient care (17.5% vs 32.6%, P=0.02).