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Subcutaneous furosemide in advanced heart failure: service improvement project
  1. Francesca Birch1,
  2. Emily Boam1,2,
  3. Sharon Parsons3,
  4. Justin Ghosh4 and
  5. Miriam J Johnson1
  1. 1 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
  2. 2 Health Education England Yorkshire and the Humber, Leeds, UK
  3. 3 Humber Mental Health Teaching NHS Trust, Willerby, East Riding of Yorkshire, UK
  4. 4 York Teaching Hospital NHS Foundation Trust, York, North Yorkshire, UK
  1. Correspondence to Professor Miriam J Johnson, Wolfson Palliative Care Research Centre, University of Hull, Hull HU6 7RX, UK; miriam.johnson{at}


Objectives In severe heart disease, parenteral administration of loop diuretic is often needed. We present clinical outcomes from episodes of care using subcutaneous continuous subcutaneous infusion of furosemide (CSCI-furosemide).

Methods Retrospective review of service improvement data. The heart failure nurse specialist, supported by the heart failure-palliative care multidisciplinary team, works with the community or hospice staff who administer the CSCI-furosemide. Data collected for consecutive patients receiving CSCI-furosemide included: age, sex, New York Heart Association (NYHA) class, preferred place of care, goal of treatment, infusion-site reactions, and signs and symptoms of fluid retention (including weight and self-reported breathlessness).

Results 116 people (men 86 (66%); mean age 79 years, 49–97; NYHA class 3 (36/116, 31%) or 4 heart failure (80/116, 69%)) received 130 episodes of CSCI-furosemide (average duration 10 days, 1–49), over half in the patient’s own home/care home (80/129,; 61%) aiming to prevent hospital admission. 40/129 (31%) were managed in the hospice, and 9 (7.0%) in a community hospital. Average daily furosemide dose was 125 mg (40–300 mg). The goal of treatment was achieved in (119/130, 91.5%) episodes.

The median reduction in weight was 4 kg (IQR −7 to −2 kgs, −22 to 9 kgs). Self-reported breathlessness reduced from 8.2 (±1.9) to 5.2 (±1.8). Adverse events occurred in 31/130 (24%) episodes; all but 4/130 (3%, localised skin infection) were mild.

Conclusions These preliminary data indicate that CSCI-furosemide is safe and effective for people with severe heart failure. An adequately powered randomised controlled trial is indicated.

  • heart failure
  • drug administration
  • service evaluation
  • symptoms and symptom management

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  • Contributors Concept: MJJ and SP; data collection SP and other clinicians as above; data management, cleaning and analysis FB, EB, JG and MJJ; first draft FB; all authors contributed to, and agreed with the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.