Subcutaneous furosemide pump: earlier discharge, more days at home

Design

Multicentre, open-label, randomised, active-controlled trial (SUBCUT-HF II)

Population

172 patients hospitalised for heart failure needing parenteral diuretics, UK

Primary outcome

Days alive and out of hospital at 30 days

Effect

+4.0 days (95% CI 2.1 to 5.8); stay 5.5 days shorter; readmission 14% vs 6% (OR 2.45, 95% CI 0.81 to 7.43)

SUBCUT-HF II was a multicentre, open-label, randomised trial in the UK. It enrolled 172 patients hospitalised with heart failure who still needed parenteral diuretics. Patients were assigned to early discharge with pH-neutral subcutaneous furosemide delivered by a wearable minipump, with a review every three days while on it, or to usual care.

Days alive and out of hospital at 30 days were 4.0 higher with early discharge (95% CI 2.1 to 5.8). The index admission was a mean 5.5 days shorter. The gain held at 60 days (4.2 days, 0.9 to 7.6) even though heart failure readmissions were more frequent with early discharge (14% vs 6%, OR 2.45, 0.81 to 7.43; the interval includes no difference). Serious adverse events were similar (25% vs 23%). Device-related problems occurred with 3% of pump placements, none serious.

The strategy depends on a pump, nurse follow-up every three days and a patient able to operate the device. In a setting where those are not available, the trial does not tell you what to do.

• Early discharge on a subcutaneous furosemide minipump gave 4.0 more days alive and out of hospital at 30 days.
• Index admission was shorter by a mean of 5.5 days.
• Heart failure readmissions were numerically higher with early discharge (14% vs 6%), with a wide interval.
• The approach needs a review every 3 days while the pump is in use, so check what follow-up capacity you have.
• This is not yet a routine option: the pump is a specific product and the trial was small and open-label.

Why it matters

It shifts the question from whether a patient can leave while still needing a diuretic to what support must surround them when they do.

Don't overread it

The trial was open-label with 172 patients and measured days at home, not hard events, so it cannot show the strategy is safe in every setting.

The statistics, in plain English

Days alive and out of hospital rolls length of stay, deaths and readmissions into one number, so a shorter first stay is rewarded unless it is cancelled by later return. The confidence interval for readmissions crosses 1.0, which means the study cannot say whether the readmission rise is real or chance, and it was not powered to settle it.

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