Ambulatory Management of Decompensated HF with Intravenous Diuretics

Pavankumar Kamat


August 17, 2021


  • 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).


  • Observational study design.

  • Significant differences in baseline characteristics between groups.

  • The ambulatory care model may not be generalisable to rural areas.


Ahmed FZ, Taylor JK, John AV, Khan MA, Zaidi AM, Mamas MA, Motwani M, Cunnington C. Ambulatory intravenous furosemide for decompensated heart failure: safe, feasible, and effective. ESC Heart Fail. 2021 Aug 12 [Epub ahead of print]. doi: 10.1002/ehf2.13368. PMID: 34382749.  View full text

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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