Early discharge on a subcutaneous furosemide pump added four days out of hospital

Design

Multicentre, open-label, randomised, active-controlled trial

Population

172 UK patients hospitalised for heart failure still requiring parenteral diuretics

Primary outcome

Days alive and out of hospital at 30 days

Effect

+4.0 days (95% CI 2.1 to 5.8); index stay 5.5 days shorter; HF readmission 14% vs 6%

SUBCUT-HF II was an open-label, randomised trial at UK centres, published in JACC on 13 October. It enrolled 172 patients admitted with heart failure who still needed parenteral diuretics. The intervention group went home early with pH-neutral subcutaneous furosemide through a wearable, patient-operated minipump, with a review every three days while on it. Both groups had a two-week clinic visit.

At 30 days, early discharge gave 4.0 more days alive and out of hospital, and the index stay was 5.5 days shorter. The gain held at 60 days. Heart failure readmissions were higher with early discharge, 14% against 6%, though the trial was too small to be sure of that difference. Serious adverse events were similar, and pump problems occurred with 3% of placements, none serious.

The trade-off is plain: fewer bed-days now, possibly more readmissions later. It works only with a follow-up system that sees patients every few days. Where a heart failure nursing team or day unit exists, this is a model for decongesting at home rather than on the ward.

In India, availability of a pH-neutral subcutaneous furosemide product and the minipump is not established; the trial's lesson is about the care pathway as much as the device.

• Identify stable inpatients whose only reason to stay is ongoing parenteral diuretic.
• Home subcutaneous diuresis needs review about every three days: weight, symptoms, renal function and potassium.
• Warn patients and teams that readmissions may be more frequent; have a clear route back in.
• Check that the subcutaneous formulation is designed for that route; standard intravenous furosemide is not.
• Book an early clinic review, within two weeks, whichever pathway is used.

Why it matters

It challenges the assumption that parenteral decongestion has to happen in a hospital bed.

Don't overread it

The trial was small and open-label; the higher readmission rate was not statistically certain either way.

The statistics, in plain English

Days alive and out of hospital rose by 4.0 (95% CI 2.1 to 5.8), so the benefit is clear. Readmissions had an odds ratio of 2.45 with a confidence interval from 0.81 to 7.43: it crosses 1, so the trial cannot say whether early discharge raises readmissions, but it cannot rule out a substantial increase either.

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