Ambulatory intravenous treatment of decompensated heart failure: An effective, safe and cost-effective approach

Abstract

Introduction and objectivesThe aim of this study was to evaluate the safety and efficacy of ambulatory intravenous (IV) treatment of decompensated heart failure (HF). MethodsRetrospective analysis of all episodes of decompensated HF treated with IV diuretics at the HF day hospital from January 1 to December 31, 2016. ResultsA total of 192 episodes of HF decompensation were treated in 119 patients. Mean age and ejection fraction were 75±11 years and 52±15%, respectively, 65% were women and 63% had chronic kidney disease. All patients were on baseline oral furosemide (average dose 140mg per day) and 21% on hydrochlorothiazide. The mean duration of each episode of ambulatory HF IV treatment was 3±2 days and mean dose of treatment was 240mg IV furosemide (80mg/treatment day), 25mg oral hydrochlorothiazide and 20mEq oral potassium per treatment day. It was possible to avoid hospitalization in 81% of the episodes (n=155 decompensations). This approach was associated with a decrease in direct hospital cost compared with hospitalization. The rate of complications was low: 4% (7 episodes) severe dyselectrolytemia and <1% (1 episode) symptomatic hypotension. There were no episodes of acute renal failure. ConclusionsA strategy of ambulatory IV diuretic treatment for HF decompensation could be effective and avoid hospital admission in a high number of patients, even in an elderly comorbid cohort with predominantly preserved LVEF. More importantly, this approach is safe with infrequent presence of dyselectrolytemia and symptomatic hypotension. This treatment was associated with a decrease in hospital cost.