Early Discharge Strategy Including Subcutaneous Furosemide in Hospitalized Heart Failure.
Ross T Campbell, Joanna Osmanska, Kieran F Docherty et al.
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In 30 seconds
This multicenter, open-label, randomized active-controlled trial in the United Kingdom studied 172 patients hospitalized with heart failure who still required parenteral diuretics. It compared usual care with an early discharge strategy using wearable-pump subcutaneous furosemide and follow-up every 3 days during treatment. At 30 days, the early discharge group had 4.0 more days alive and out of hospital (95% CI: 2.1-5.8 days; P < 0.001). The strategy also shortened the index hospitalization, while heart failure readmissions were more frequent in the early discharge group.
Key findings
- At 30 days, early discharge increased days alive and out of hospital by 4.0 days (95% CI: 2.1-5.8 days; P < 0.001).
- Index hospitalization was shorter by a mean of 5.5 days (95% CI: 7.4-3.6 days; P < 0.001).
- At 60 days, the difference in days alive and out of hospital was 4.2 days (95% CI: 0.9-7.6 days).
- Heart failure readmissions occurred in 13 (14%) early-discharge patients versus 5 (6%) usual-care patients; serious adverse events occurred in 25% and 23%, respectively.
Why it matters
The trial suggests that selected hospitalized patients who still need parenteral diuretics may spend fewer days in hospital and more days alive outside hospital when supported by a structured early-discharge pathway. The higher observed number of heart failure readmissions is also relevant when weighing the overall benefit and planning postdischarge monitoring.
What to keep in mind
The trial was open-label, and the abstract reports follow-up outcomes only through 60 days. Heart failure readmissions were more frequent with early discharge, although the reported confidence interval for the odds ratio was wide.