Takeaway
- Ambulatory management of decompensated heart failure (HF) with intravenous diuretics either on a day-case unit or in a domiciliary setting was feasible, safe and effective in selected patients compared with standard of care.
Why this matters
- Findings urge the need to explore and implement the ambulatory model of care in delivering outpatient HF treatment during COVID-19.
Study details
- This retrospective study assessed 154 patients with 203 episodes of decompensated HF managed by intravenous diuretic treatment (furosemide) either in an ambulatory setting (n=79; 114 episodes) on a day-case unit or domiciliary care or in an inpatient hospitalisation setting (n=75; 89 episodes).
- Funding: None.
Key results
- There was no difference in the proportion of uncomplicated treatment episodes (84.1% vs 82.1%; P=.84) and the median duration of intravenous diuretic treatment (6 vs 7 days; P=.3) in patients managed with ambulatory service vs inpatient hospitalisation.
- Acute kidney injury occurred less frequently in patients receiving ambulatory service than in inpatients (P=.03).
- There was no difference in the incidence of 30-day HF readmissions in patients receiving ambulatory vs in-hospital treatment (14.9% vs 13.5%; P=.8).
- The rate of 30-day mortality was significantly lower in the ambulatory group vs the inpatient group (3.5% vs 21.3%; P<.001).
Limitations
- Observational study design.
- Significant differences in baseline characteristics between groups.
- The ambulatory care model may not be generalisable to rural areas.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
