Early discharge on subcutaneous furosemide added four days alive and out of hospital

Design

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

Population

172 UK inpatients with heart failure still needing parenteral diuretics

Primary outcome

Days alive and out of hospital at 30 days

Effect

+4.0 days (95% CI 2.1 to 5.8); +4.2 days at 60 days (0.9 to 7.6)

SUBCUT-HF II randomised 172 inpatients with heart failure who still needed parenteral diuretics either to continued usual inpatient care or to early discharge with subcutaneous furosemide delivered by a wearable minipump the patient operated. Early discharge patients were reviewed every three days while on the pump; both groups had a two-week clinic visit.

Early discharge gave four more days alive and out of hospital at 30 days and shortened the index stay by 5.5 days. The gain held at 60 days. Heart failure readmissions were more frequent with early discharge, 14% against 6%, though the estimate was imprecise. Serious adverse events were similar.

The model depends on a heart failure team able to see patients at home or in clinic every few days. Without that, the readmission signal becomes the dominant concern.

• The strategy relied on review every three days while on the pump.
• Index stay was 5.5 days shorter on average.
• Plan for a re-admission pathway, since readmissions were more frequent.
• Device problems occurred in 3% of pump placements, none serious.
• Availability of the pH-neutral subcutaneous preparation and minipump in India is not known.

Why it matters

Patients often stay in hospital only for a diuretic infusion, and this trial shows that step can safely move home with close follow-up.

Don't overread it

Heart failure readmissions were higher with early discharge (14% vs 6%), an imprecise estimate in a small open-label trial.

The statistics, in plain English

Days alive and out of hospital adds up time at home and counts deaths and readmissions against it. The readmission odds ratio of 2.45 has an interval from 0.81 to 7.43, which crosses 1, so the trial cannot say whether the increase is real; it was not powered to.

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