Background
Heart failure can result in accumulation of fluid in both the periphery (peripheral oedema) and within the lungs (pulmonary oedema). Traditionally, intravenous diuretics such as furosemide are used to remove this fluid, necessitating a potential lengthy hospital admission. Recently, ambulatory diuretic services have been set up, to provide IV diuretics on an outpatient basis. Purpose
Worcestershire Royal Hospital's ambulatory diuretic service began in April 2018 to provide a way of reducing hospital admissions for patients with decompensated heart failure, based on defined eligibility and exclusion criteria. The effectiveness, outcomes, and safety, of this service have yet to be formally assessed, and it is through a service evaluation that we aim to achieve this. Methods
A service evaluation utilising previously collected data, from April 2018 to August 2023, was performed. Data collected included the duration of ambulatory diuretic treatment, diuretic dosages, physical (blood pressure, heart rate, weight) and electrolyte parameters before and after treatment. Medication usage before and after treatment was also recorded, alongside any complications that occurred; defined as hypokalaemia requiring supplementation, acute kidney injury, diarrhoea, hypotension, or hospitalisation. Characteristics and outcomes of non-responders, defined as failing to lose ≥2 kg, were evaluated. Data was processed using Microsoft Excel. P-values were calculated for parametric continuous data using Student's t-test, non-parametric continuous data using the Mann-Whitney U test, and categorical variables using Fisher's exact test. Results
We analysed the results of 57 patients across 72 treatment episodes. This represents approximately 2.2% of all hospital admissions for heart failure over the evaluation period. The mean age was 73.8 years (SD= 10.9), 79.2% were male, 46.5% had a diagnosis of HFrEF, with 25.4% having HFpEF. Overall, we estimate 473 hospital in-patient days were averted. The median weight loss was 3.8 kg (range -16.9 to +2.25 kg). Complications occurred in 61.1%, with hypokalaemia being the most common complication (48.6%). AKI occurred in 15.3%. No deaths occurred during the treatment period. 16 treatment episodes (22.2%) involved non-responders. There was no difference in diuretic doses administered to this group compared to responders. These patients were older, more symptomatic, had higher NT-proBNP levels, lower eGFR at baseline, experience more complications, and had a worse 12-month mortality post-discharge (56.2%) than those who responded (23.5%). Conclusions
Outpatient, ambulatory, diuretic services have the potential to reduce hospital admissions, and thus save a substantial number of bed days, for a small proportion of decompensated heart failure patients. Complication rates were relatively high but were largely driven by electrolyte changes. Overall, non-responders had worse outcomes compared to responders. Conflict of Interest
No conflict of interest