Outpatient Diuretic Protocol Can Keep Some Heart Failure Patients Out of Hospital

MedicalResearch.com Interview with:

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

Dr. Leo Buckley

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

MedicalResearch.com: What is the background for this study?

Response: As the prevalence and costs of heart failure are expected to increase through the year 2030, significant efforts have been devoted towards devising alternatives to inpatient hospitalization for the management of heart failure decompensations. Since loop diuretics are the mainstay of treatment during the majority of hospitalizations, administration of high doses of loop diuretics in the outpatient setting has increased in popularity.

We intended to answer two questions with his study: first, can a patient-specific dosing protocol based on a patient’s usual diuretic dose achieve safe decongestion? and second, does this strategy alter the usual course of heart failure decompensation, which oftentimes culminates in inpatient hospitalization?

MedicalResearch.com: What are the main findings?

Response: We found that our dosing protocol was safe and effective across a wide range of usual diuretic doses, from patients still maintained on a starting dose of furosemide to patients with diuretic resistance on over 300 mg of furosemide-equivalent and a thiazide booster. Importantly, these benefits were achieved in both patients with HFrEF and HFpEF.

MedicalResearch.com: What should readers take away from your report?

Response: Select patients with acute decompensated heart failure who would otherwise require inpatient hospitalization can be safely managed in the outpatient setting with protocol-based administration of loop diuretics. Reducing hospitalizations has become of paramount importance and investigation of alternatives to hospitalizations may identify the needed solutions.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Studies such as STRATIFY are needed to define the decompensated heart failure patients who can be best served with a short stay in an observation unit or complete outpatient management.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


Comparison of Ambulatory, High-Dose, Intravenous Diuretic Therapy to Standard Hospitalization and Diuretic Therapy for Treatment of Acute Decompensated Heart Failure
Leo F. Buckley, PharmD , Enrique Seoane-Vazquez, PhD, Judy W.M. Cheng, PharmD MPH, Ahmed Aldemerdash, PharmD, Irene M. Cooper, RN, Lina Matta, PharmD MPH, Danika S. Medina, RN, Mandeep R. Mehra, MD, Kristina Navarro-Velez, RN, Elaine L. Shea, RN, Joanne R. Weintraub, NP, Lynne W. Stevenson, MD, Akshay S. Desai, MD MPH
DOI: http://dx.doi.org/10.1016/j.amjcard.2016.07.068
August 13, 2016

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