Subcutaneous Furosemide for Ambulatory Decongestion in Heart Failure: Outcomes From a High‐Risk Real‐World Cohort

BACKGROUND: Volume overload remains a primary driver of heart failure hospitalization (HFH). Diuretic resistance limits the efficacy of oral loop diuretics during decompensation, often necessitating intravenous therapy. Subcutaneous (SC) furosemide (Furoscix, 80 mg/10 mL) represents a novel outpatient alternative for patients who remain symptomatic despite oral diuretic therapy. OBJECTIVES: To evaluate the clinical outcomes of SC furosemide in ambulatory heart failure (HF) patients inadequately managed with oral loop diuretics. METHODS: We performed a single-center retrospective cohort study of HF patients prescribed SC furosemide as an adjunct to oral loop diuretics between May 2023 and 2025. The primary outcome was HFH within 30 days of initiation. Secondary outcomes included a composite of HFH or urgent care or emergency department visits requiring intravenous diuresis, change in body weight, and New York Heart Association (NYHA) functional class. RESULTS: Fifty patients met the inclusion criteria; one was excluded for incomplete follow-up. SC furosemide was prescribed as two to three doses per week. Within 30 days, 10 patients (20.4%) experienced HFH; six had been hospitalized in the preceding 30 days, suggesting a high-risk baseline cohort. The composite endpoint occurred in 16 patients (32.7%). Among patients who avoided hospitalization, median NYHA class improved from III to II, and mean body weight decreased by 2.6 kg (5.7 lbs). Adverse events were infrequent; no deaths occurred within the 30-day follow-up period. CONCLUSION: In ambulatory HF patients with persistent congestion despite oral diuretic therapy, SC furosemide was well tolerated and associated with improvements in functional status and volume burden.