Subcutaneous furosemide in advanced heart failure: service improvement project

Birch, Francesca; Boam, Emily; Parsons, Sharon; Ghosh, Justin; Johnson, Miriam J

Abstract

Objectives: In severe heart disease, parenteral administration of loop diuretic is often needed. We present clinical outcomes from episodes of care using subcutaneous continuous infusion of furosemide (CSCI-furosemide).

Methods: Retrospective review of service improvement data. The heart failure nurse specialist, supported by the heart failure-palliative care multi-disciplinary team, works with the community or hospice staff who administer the CSCI-furosemide. Data collected for consecutive patients receiving CSCI-furosemide included: age, sex, New York Heart Association (NYHA) class, preferred place of care, goal of treatment, infusion-site reactions, and signs and symptoms of fluid retention (including weight and self-reported breathlessness).

Results: 116 people (men 86 [66%]; mean age 79 years, 49 to 97; NYHA class 3 [36/116, 31%] or 4 heart failure [80/116, 69%]) received 130 episodes of CSCI-furosemide (average duration 10 days, 1 to 49), over half in the patient’s own home/care home (80/129,; 61%) aiming to prevent hospital admission. 40/129 (31%) were managed in the hospice, and 9 (7.0%) in a community hospital. Average daily furosemide dose was 125 mg (40 to 300mg). The goal of treatment was achieved in (119/130, 91.5%) episodes.

The median reduction in weight was 4kg (interquartiles -7 kg to -2 kgs, -22 to +9 kgs). Self-reported breathlessness reduced from 8.2 (+/-1.9) to 5.2 (+/-1.8). Adverse events occurred in 31/130 (24%) episodes; all but 4/130 (3%, localised skin infection) were mild.

Conclusions: These preliminary data indicate that CSCI-furosemide is safe and effective for people with severe heart failure. An adequately powered randomised controlled trial is indicated.

Citation

Birch, F., Boam, E., Parsons, S., Ghosh, J., & Johnson, M. J. (in press). Subcutaneous furosemide in advanced heart failure: service improvement project. BMJ supportive & palliative care, https://doi.org/10.1136/bmjspcare-2020-002803

• Journal Article Type: Article
• Acceptance Date: Dec 16, 2020
• Online Publication Date: Jan 15, 2021
• Deposit Date: Dec 18, 2020
• Publicly Available Date: Feb 17, 2021
• Journal: BMJ supportive & palliative care
• Print ISSN: 2045-435X
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1136/bmjspcare-2020-002803
• Public URL: https://hull-repository.worktribe.com/output/3679786