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Furosemide in end-stage heart failure: community subcutaneous infusions
Andrew Brown1, Katharine Westley1, Judith Robson1
1Cardiology Department, Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK.
BMJ Supportive & Palliative Care
|July 11, 2020
Summary
Continuous subcutaneous infusion (CSCI) furosemide effectively manages advanced heart failure symptoms, reducing hospital admissions and enabling palliative care at home. This treatment offers improved patient choice and symptom control for chronic heart failure patients.
Area of Science:
- Cardiology
- Palliative Care
- Pharmacology
Background:
- Chronic heart failure frequently causes recurrent hospital admissions, particularly in individuals over 65.
- Limited evidence exists for subcutaneous furosemide use in end-stage heart failure to alleviate symptoms and prevent hospitalization.
Purpose of the Study:
- To establish a community-based continuous subcutaneous infusion (CSCI) furosemide service for advanced heart failure.
- To enhance patient autonomy, provide an alternative to hospital admission, and facilitate symptom management for end-of-life care at home.
Main Methods:
- Retrospective case note review of 36 consecutive CSCI furosemide treatment episodes in 28 advanced heart failure patients.
- Evaluation of patient outcomes including hospital admission rates, symptom control, and place of death.
Main Results:
- 13 out of 15 patients (87%) avoided acute hospital admission, with a significant reduction in mean admission rates (2.87 to 0.73).
- A median weight loss of 4kg was observed.
- 12 out of 13 patients who died during treatment (92%) passed away at home with controlled symptoms.
Conclusions:
- Community-administered subcutaneous furosemide is a viable treatment option for advanced heart failure.
- This approach effectively manages symptoms, promotes weight loss, and supports palliative care, allowing patients to remain at home during their final months.
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