DOME-HF: Three-month outcomes of a diuretic day-hospital model for elderly patients with acute heart failure

Background Heart failure (HF) remains a leading cause of hospitalization and mortality among older adults. Conventional inpatient care exposes frail patients to iatrogenic complications, loss of autonomy, and prolonged deconditioning. Outpatient intravenous (IV) diuretic therapy delivered within a structured day-hospital (DH) pathway may offer a safe, efficient, and patient-centered alternative. The DOME-HF program integrates cardiology and geriatrics to deliver IV diuretics, comprehensive reassessment, and early follow-up for very elderly patients with acute HF , aiming to preserve function and reduce avoidable readmissions. Purpose To describe the clinical and geriatric profile, organization of care, and short-term (3-month) outcomes of older adults managed for acute HF through a dedicated cardiogeriatric DH model. Methods This single-center, retrospective observational study included all patients aged ≥65 years managed in a cardiogeriatric DH between January and June 2025 for IV diuretic therapy. Sociodemographic, geriatric, and cardiologic data, DH organization, and 3-month outcomes were extracted from medical records. The DH provided same-day evaluation, tailored IV diuretic therapy, medication adjustment, and multidisciplinary review. Telemonitoring and collaboration with community providers ensured continuity and early detection of recurrence or suboptimal decongestion. Results Forty patients (mean age 88 ± 6.8 years; 47.5 % female) were included. Most lived at home (95 %) and had 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 % ischemic cardiomyopathy. Mean NT-proBNP at discharge was 3999 ± 4326 pg/mL. The mean delay between referral and first DH session was 1.6 ± 1.9 days, with 2.2 ± 1.6 sessions per patient. At 3 months, HF readmission was 20 %, all-cause readmission 40 %, HF mortality 2.5 %, and all-cause mortality 7.5 %. Conclusion The DOME-HF program demonstrates that IV diuretic therapy can be safely and effectively delivered in a cardiogeriatric DH for very elderly, multimorbid HF patients. This integrated, multidisciplinary model enables rapid decongestion, therapeutic optimization, and functional preservation, while limiting early rehospitalizations. As the first French cardiogeriatric DH reporting real-world outcomes, DOME-HF exemplifies a pragmatic, scalable, and resource-efficient alternative to conventional hospitalization for frail older adults, fully aligned with ESC 2021 recommendations on multidisciplinary HF care.