Subcutaneous furosemide in heart failure: a systematic review
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Why the study?
Recently developed pH-neutral, concentrated, skin-friendly furosemide preparations allow subcutaneous administration, but evidence for their use in heart failure required systematic review and appraisal.
Does subcutaneous furosemide provide similar bioavailability, diuresis, and natriuresis compared to intravenous or oral furosemide in patients with heart failure?
Population
Patients with HF across 17 identified studies
Comparison
Novel pH-neutral subcutaneous furosemide vs intravenous furosemide or conventional subcutaneous preparations
Design
Systematic review of 17 studies (5 RCTs, 2 non-randomized, 10 observational)
Authors
Discussion
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Implication
Subcutaneous furosemide may enable outpatient diuresis in decompensated HF; extends loop diuretic options beyond IV administration.
Structured PICO
Does subcutaneous furosemide provide similar bioavailability, diuresis, and natriuresis compared to intravenous or oral furosemide in patients with heart failure?
P
Population
Patients with heart failure (chronic or decompensated). 17 studies identified (5 RCTs pooling 138 patients, 2 non-randomized controlled, 3 prospective observational, 7 retrospective). Median age ranged 56-75 years, mostly male, mostly HFrEF. Excluded patients with advanced renal disease.
I
Intervention
Subcutaneous furosemide (novel pH-neutral preparations at 8 mg/mL or 30 mg/mL in RCTs; conventional preparations in observational studies)
C
Comparator
Intravenous or oral furosemide (in controlled studies) or usual care
O
Outcome
Bioavailability, diuresis (urine output), natriuresis, and safety/tolerability (adverse events)surrogate
Novel pH-neutral subcutaneous furosemide offers a viable, well-tolerated alternative to intravenous diuretics for congestion management in heart failure, achieving comparable bioavailability and diuresis.
Limitations
- Small number of RCTs
- Small number of participants in included trials
- Variable outcomes of interest preventing pooled meta-analysis
- Heterogeneity of study designs
- No blinding of treatment allocation in any of the trials
Cite This Study
Osmanska et al. (2024) studied this question.
Topics
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