The edition · Cardiology
Subcutaneous furosemide at home shortened heart failure admissions by five days
A UK trial sent decongesting patients home on a wearable diuretic pump, plaque composition sorted who gained from preventive PCI, and amyloid hearts need their own mitral thresholds.
The edition in brief
SUBCUT-HF II (JACC, 13 October) randomised 172 UK patients still needing parenteral diuretics for heart failure to early discharge on subcutaneous furosemide from a wearable minipump, with reviews every three days, or usual inpatient care. Early discharge gave 4.0 more days alive and out of hospital at 30 days and shortened the index stay by 5.5 days, but heart failure readmissions were numerically higher (14% vs 6%). A post hoc analysis of the PREVENT trial (Circulation, 6 October) found that preventive PCI of non-flow-limiting, high-burden plaques was associated with fewer events only when near-infrared spectroscopy showed a lipid-rich core (7.3% vs 17.6%, adjusted HR 0.23), and not otherwise. A 1101-patient international cohort (Circulation, 13 October) found mitral regurgitation in transthyretin amyloid cardiomyopathy carries prognostic weight at volumes well below guideline cut-offs, classifying 21% as severe against 12 to 13% by guideline grading. The pearl covers checking diuretic response early with spot urine sodium. The 2026 ACC scientific statement on exercise prescription (JACC, 15 October) closes the edition: prescribe exercise as therapy, start with the inactive, and skip routine pre-participation testing in most asymptomatic adults.
Early discharge on a subcutaneous furosemide pump added four days out of hospital
Where close follow-up exists, consider early discharge on subcutaneous furosemide for stable patients still needing parenteral diuretics.
Preventive PCI was linked to fewer events only in lipid-rich plaques
Do not stent non-flow-limiting plaques on this analysis; it suggests plaque composition, not size, may decide who benefits.
In amyloid cardiomyopathy, mitral regurgitation matters at lower volumes
In amyloid cardiomyopathy, quantify mitral regurgitation and treat lower volumes as prognostically significant.
Check diuretic response within hours, not days
Measure urine sodium two hours after the first loop dose and escalate early if the response is poor.
An ACC statement treats exercise as a prescription, without routine pre-testing
Prescribe exercise at every cardiovascular review, and reserve pre-exercise testing for those who need it.
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