Continuous subcutaneous infusion of furosemide for treatment of decompensated heart failure in frail older people in a Hospital at Home Service

Decompensated heart failure is a common acute presentation to hospital amongst the frail older population (1). Treatment often involves intravenous furosemide, which is effective in inducing potent diuresis.​

However, this treatment can be associated with negative effects of hospital stay, such as hospital-associated infections, delirium and deconditioning.  These risks are particularly significant for patients living with frailty, for whom admission can increase dependency, increase likelihood of readmission, and contribute to higher mortality. For many individuals with frailty, personal priorities of care differ from traditional disease-centred outcomes with a prioritisation of maintaining independence and autonomy in their preferred place of care over aggressive therapeutic interventions. Conventional inpatient care does not always align with these goals, highlighting the importance of treatment approaches that can be delivered outside the hospital setting.​

Continuous subcutaneous infusion (CSCI) of furosemide is well-established as a palliative treatment for end-stage heart failure (2). There is growing evidence that CSCI of Furosemide is as safe and efficacious as intravenous in the management of acute decompensation (3). Additionally, CSCI is delivered via a compact, portable device that can be worn by the patient, enabling freedom of movement and supporting functional ability in the comfort of their own home. Hospital syringe pumps are larger devices that restrict mobility as they are attached to a drip stand and often require mains power supply. ​

Use of CSCI Furosemide in the community therefore supports a holistic model of care, whilst being an effective treatment. It is used by some Hospital at Home (HaH) services, but research into patient experiences of this therapy is limited.  

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