The edition · Cardiology
Subcutaneous furosemide at home added four days out of hospital in heart failure, though readmissions ran higher
SUBCUT-HF II on early discharge with a furosemide minipump, a global estimate of antihypertensive adherence, dapagliflozin after TAVI by frailty, and pooled data on CRT in cancer therapy-related cardiac dysfunction.
The edition in brief
SUBCUT-HF II, a UK open-label randomised trial in 172 patients still needing parenteral diuretics, found that discharging early on subcutaneous furosemide through a wearable minipump gave 4.0 more days alive and out of hospital at 30 days and shortened the index stay by 5.5 days. Heart failure readmissions were numerically higher with early discharge (14% vs 6%), an imprecise estimate. A meta-analysis of 123 studies and over a million adults estimated that only 58% take antihypertensives as prescribed, with no difference by country income. A post hoc analysis of DapaTAVI found dapagliflozin after TAVI was associated with fewer deaths or heart failure worsenings in frail patients (HR 0.53) but not in prefrail or robust ones; this is a subgroup finding. A meta-analysis of four small observational studies (110 patients) found CRT raised ejection fraction by about 10 points in cancer therapy-related cardiac dysfunction, similar to other non-ischaemic cardiomyopathies. The pearl covers checking adherence before labelling hypertension resistant.
Only about 58% of adults with hypertension take their tablets as prescribed
Ask about adherence, in a non-judgemental way, before adding a drug for uncontrolled blood pressure.
Dapagliflozin after TAVI was associated with benefit in frail patients but not in robust ones
Frailty should not, on its own, be a reason to withhold an SGLT2 inhibitor after TAVI.
CRT raised ejection fraction by about 10 points in cancer therapy-related cardiac dysfunction
Consider CRT for cancer survivors with cardiomyopathy who meet the usual criteria, with the decision shared with the oncology team.
Rule out non-adherence and white-coat effect before calling hypertension resistant
Before adding a fourth drug, confirm adherence and check out-of-office readings.
Early discharge on subcutaneous furosemide added four days alive and out of hospital
Where a supervised home service exists, early discharge on subcutaneous furosemide is a reasonable option for stable patients still needing parenteral diuretics.
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