Furosemide in end-stage heart failure: community subcutaneous infusions.
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Authors
Brown, Andrew
Westley, Katherine
Robson, Judith
Armstrong, Leonie
Matthews, Iain
Runnett, Craig
Ripley, David
Thomas, Honey
Issue Date
2022
Type
Article
Language
en
Keywords
heart failure , Furosemide , subcutaneous infusion
Alternative Title
Abstract
Background: In chronic heart failure many patients have recurrent hospital admissions and it is the leading cause of admission in people aged over 65 years. In those with end-stage heart failure, there is limited evidence that furosemide can be given subcutaneously to relieve symptoms and avoid hospital admission.
Method: We initiated a community-based continuous subcutaneous infusion (CSCI) furosemide service for the treatment of advanced heart failure. We aimed to increase patient choice, offer an alternative to hospital admission and, in patients at the end of their life, allow them to die at their preferred place of care with symptom alleviation. We retrospectively reviewed case notes.
Results: 36 consecutive episodes of CSCI of treatment were recorded in 28 patients. 15 patients (54%) survived beyond the initial treatment course with 13 patients (87%) avoiding acute hospital admission. There was a reduction in mean hospital admission rates from 2.87 to 0.73 (p<0.001) in the 6-month periods either side of the first episode of CSCI furosemide. A median reduction of 4kg weight loss was recorded. 13 patients died during the initial treatment course. 12 (92%) died at home and 1 died at the hospital palliative care unit. All had symptoms controlled.
Conclusion: Subcutaneous furosemide can be successfully delivered in the community. In addition to palliation in the final days of life, community subcutaneous furosemide can be an effective treatment leading to weight loss and improved symptoms with survival for several months.
Description
Citation
Brown, A., Westley, K., Robson, J. et al. (2022) Furosemide in end-stage heart failure: community subcutaneous infusions. BMJ Supportive & Palliative Care; 12 (e6) : e763-e766.
Publisher
License
Journal
BMJ Supportive and Palliative Care
Volume
Issue
ISSN
2045-4368