Early Discharge Strategy Including Subcutaneous Furosemide in Hospitalized Heart Failure

BackgroundPatients hospitalized for heart failure often require prolonged intravenous diuretic therapy, contributing to costs and risks associated with inpatient care. ObjectivesWe evaluated whether an early discharge strategy using subcutaneous furosemide delivered via a wearable minipump could increase days alive and out of hospital (DAOH). MethodsIn this multicenter, open-label, randomized, active-controlled trial in the United Kingdom, 172 patients hospitalized for heart failure requiring ongoing parenteral diuretics were randomly assigned to an early discharge strategy or usual care. Patients in the early discharge group received pH-neutral subcutaneous furosemide via a wearable, patient-operated minipump; postdischarge care included a review every 3 days while receiving subcutaneous furosemide. Both groups had a 2-week clinic review. The primary outcome was DAOH at 30 days after randomization. ResultsA total of 92 patients were assigned to early discharge and 80 to usual care. The early discharge strategy resulted in 4.0 more DAOH at 30 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). The benefit in DAOH was sustained at 60 days (difference 4.2 days; 95% CI: 0.9-7.6 days), despite more heart failure readmissions in the early discharge group (13 [14%] patients vs 5 [6%] patients; OR: 2.45; 95% CI: 0.81-7.43). Serious adverse events occurred in 25% and 23% of patients, respectively. Device-related problems occurred with 3% of minipump placements, but none were serious. ConclusionsAn early discharge strategy using a subcutaneous furosemide minipump increased DAOH compared with usual care. (Use of a Novel SUBCUTaneous Preparation of Furosemide to Facilitate Early Supported Discharge of Patients With Heart Failure [SUBCUT-HF II]; NCT05419115).