Ambulatory Diuretic Therapy for Some Heart Failure Patients Can Reduce Costs and Hospitalizations Interview with:

Leo F. Buckley, PharmD Virginia Commonwealth University Richmond, Virginia

Dr. Leo Buckley

Leo F. Buckley, PharmD
Virginia Commonwealth University
Richmond, Virginia What is the background for this study?

Response: Heart failure hospitalizations have become a significant burden for both patients and the healthcare systems. Significant efforts have been devoted to identifying alternative treatment pathways for acute decompensated heart failure that do not require hospitalization. Our group previously reported our initial experience with ambulatory intravenous diuretic therapy administered serially over several days to weeks in place of inpatient hospitalization. We found that the rate of hospitalization was significantly reduced compared to expected and that the high dose furosemide protocol utilized was safe and well tolerated by patients. What are the main findings?

Response: In the current report, we turned towards the economic aspects of this strategy and utilized a decision analytic model to gauge financial implications. During the 3 months after the index heart failure decompensation, treatment with the ambulatory-first approach (with “rescue” hospitalization if necessary) would be cost-saving and require fewer hospitalizations than a hospitalization-first approach. Most important, these cost savings

1) extended for months beyond the initial decompensation and

2) remained constant despite several extreme variations in our model’s inputs. What should readers take away from your report?

Response: This study demonstrates that an ambulatory-first approach to acute decompensated heart failure not only averts hospitalization for several months but also results in significant cost-savings. As the healthcare system looks to hospital alternative, novel treatment approaches such as ambulatory diuretic therapy and observation units may begin to play a significant role in the management of heart failure. What recommendations do you have for future research as a result of this study?

Response: Larger, multicenter prospective studies are required to expand these findings beyond our own institution. Thank you for your contribution to the community.


Buckley LF, Carter DM, Matta L, et al. Intravenous Diuretic Therapy for the Management of Heart Failure and Volume Overload in a Multidisciplinary Outpatient Unit. JCHF.2016;4(1):1-8. doi:10.1016/j.jchf.2015.06.017.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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