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Subcutaneous furosemide in advanced heart failure: service improvement project

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


Francesca Birch

Emily Boam

Sharon Parsons

Justin Ghosh


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.


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,

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
Public URL


Article (94 Kb)

Copyright Statement
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

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