Home intravenous diuretic therapy for advanced heart failure: experience from a mobile support unit program

Background: Advanced heart failure (AHF) is marked by refractory congestion, resulting in recurrent hospitalizations and poor outcomes. Ambulatory intravenous (IV) diuretics may reduce healthcare utilization. Our institution implemented the Home Support Mobile Unit (HSMU) to deliver home-based IV diuretic therapy under specialized nursing supervision. This study aims to describe the program and assess its impact on hospitalizations and emergency department (ED) visits in AHF. Methods: Retrospective, single-center study of 28 patients with AHF who received home-based IV furosemide through HSMU between 2018 and 2025. Eligible patients had recurrent HF admissions, dependence on IV diuretics, New York Heart Association (NYHA) III–IV symptoms, and were ineligible for transplantation. Rates of hospitalizations and ED visits were compared between the 12-months preceding HSMU enrolment and the entire follow-up period in the program using generalized estimating equations with negative binomial models adjusted for exposure time. Results: Patients were elderly (mean age 74.6 ± 10 years), predominantly male (60.7%), with severe systolic dysfunction [mean left ventricular ejection fraction (LVEF) 35.8 ± 13.6%]. Median program duration was 121 days [interquartile range (IQR) 24–277]. Continuous IV infusion was used in 90.5% of cases. The median daily furosemide dose was 200 mg (IQR 133). The combined rate of all-cause hospitalizations and ED visits dropped by 46% (p = 0.003), all-cause hospitalizations decreased by 47% (p = 0.002), and the combined rate of HF hospitalizations and ED visits declined by 40% (p = 0.028). Complications (n = 4; 14.3%) included acute kidney injury and electrolyte imbalance and were managed with short hospital stays. Conclusions: Home-based high-dose IV furosemide therapy was safe and reduced healthcare utilization in AHF, supporting its value within multidisciplinary home palliative care.