Response to ‘Potential negative economic effects of diuretic lounge’

We would like to thank Dr Watanabe for expressing an interest in our study, which demonstrated that the use of ambulatory intravenous diuretics can help avoid hospital admissions for heart failure patients requiring decongestion.1 Dr Watanabe has raised some concerns regarding the financial model within our study. Since the diuretic lounge opened at our institution, there has been a significant reduction in the number of acute heart failure hospital admissions, but the length of stay of those admitted has also increased. Those requiring admission were more likely to be unstable (e.g. requiring supplementary oxygen) and therefore required a prolonged length of treatment. Outpatient intravenous diuresis is well established in the USA and has resulted in significant improvements in symptoms and quality of life for heart failure patients. It also reduces hospital admissions and importantly decreases the financial burden on healthcare systems.2–4 Anticipated savings of an outpatient approach show that the average cost of a diuretic clinic visit is significantly less than a hospital admission, with an estimated saving of over $12 000 per annum.4Cross-sectional analysis of Medicare Beneficiaries in the USA demonstrated that moving heart failure treatment to the outpatient setting saved $2098 billion if only 20% of admissions were targeted.5 We acknowledge that our financial model does have limitations, however, based on data from previous studies in the USA, we believe the introduction of a nationwide outpatient intravenous diuretic service could be a cost-effective strategy for the National Health Service. Conflict of interest. None Declared.