Abstract
Intro: Decompensated heart failure is a common acute presentation to hospital amongst the frail older population where treatment often involves intravenous furosemide. Whilst this is effective in inducing a diuresis, it can be associated with negative effects of hospital stay such as hospital-associated infections and deconditioning. Continuous subcutaneous infusion (CSCI) of furosemide is well-established as a palliative treatment for end-stage heart failure and there is growing evidence that CSCI Furosemide is as safe and effective as intravenous in the management of acute episodes of decompensation, whilst preventing hospital admission. This study retrospectively assesses the use and effectiveness of CSCI Furosemide for patients under York Virtual Frailty Ward.
Methods: 10 episodes of care using CSCI of furosemide were identified between November 2023 and May 2025. Included care episodes were those where patients received CSCI Furosemide, had a diagnosis of end stage heart failure and were housebound (CFS ≥6). All individuals received either 160mg or 230mg of CSCI Furosemide over a minimum treatment course of 48 hours. Patient records were reviewed to assess weight change and symptom burden pre- and post-CSCI Furosemide. Bed days saved by preventing hospital admission were calculated.
Results: The average weight loss through treatment was 0.83kg/24 hours. All patients reported an improvement in symptom burden (oedema/mobility/breathing/fatigue). Two patients experienced a mild localised skin reaction, but treatment was able to continue safely with modifications. 40 bed days were found to have prevented through this community treatment.
Conclusions: This study demonstrates that CSCI is an effective treatment for management of decompensated heart failure of frail older individuals in the community. Although mild adverse effects may occur, they were short lived and did not prevent the treatment continuing. CSCI Furosemide offers benefits beyond its intended use including reducing risk of hospital-acquired harm and prevention of hospital bed days in an already strained system.
Comments
Heart failure management in the community
How do you closely monitor fluid and electrolyte imbalance while on continuous frusemide at home or in the community and at what point do you stop the infusion to start oral diuretics? Thankyou
Hello, thank you very much…
Hello, thank you very much for your interest.
We conduct daily home visits for patients receiving CSCI Furosemide, during which we record daily weights and observations to help assess their fluid status. We also perform daily U+Es, which are sent to the hospital laboratory, results are typically available within 3–5 hours, allowing us to review them on the same day in most cases.
Response to treatment is evaluated through clinical assessment (symptomatic improvement, visible reduction in peripheral oedema) and by monitoring weight loss.
I hope this provides some clarity, please do let me know if there’s anything further I can explain or expand on.
Interesting project. Did you…
Interesting project. Did you check baseline renal function in these patients and monitor renal function during therapy?
I can see patients were weighed to help assess fluid balance, were patients expected to record fluid intake and output too?
Is there a specific limit on patient numbers who could receive this intervention? and if so is this limited by staff numbers or by infusion device numbers?
Thank you for taking the…
Thank you for taking the time to review our poster.
We conduct daily home visits for patients receiving CSCI Furosemide, during which we take daily U+Es to monitor baseline and ongoing renal function throughout treatment.
We did not strictly monitor fluid input and output, instead, we assessed treatment response primarily through weight loss, symptomatic improvement, and visible reduction in peripheral oedema.
There is currently no set limit on the number of patients we can treat at one time. So far, this has not been an issue, as we have typically had only one or two patients on our caseload requiring CSCI Furosemide concurrently. We do not anticipate being limited by device availability, as we can liaise with our district nursing colleagues to use their existing syringe drivers, which is one of the advantages of this method compared to IV infusion pumps, as syringe drivers are already widely used and easily accessible in the community.
The main limiting factor would likely be staffing capacity, as the treatment requires daily nursing visits to replace the syringe driver and daily visits from our team for ongoing monitoring.