Subcutaneous Furosemide May Offer Effective Home-Based Treatment for Heart Failure, suggests new Pilot Study

However, the study did not achieve its primary efficacy endpoint, which included cardiovascular death, heart failure events, and changes in N-terminal pro–B-type natriuretic peptide (NT-proBNP), as reported in a recent paper published in JACC: Heart Failure.

Heart failure often leads to significant fluid retention, causing patients to experience worsening congestion and difficulty breathing. Traditionally, such cases require hospitalization for intravenous diuretics to alleviate symptoms. Therapies are required to address worsening congestion, without hospitalization, in patients with chronic HF.

In this context, Marvin A. Konstam from Tufts Medical Center and Tufts University School of Medicine in Boston and colleagues conducted a pilot study to evaluate the outcomes of a novel SC furosemide formulation versus standard care in outpatients experiencing worsening congestion.

For this purpose, the researchers randomly assigned participants with chronic heart failure and worsening congestion in a 2:1 ratio to receive either subcutaneous furosemide or usual care (UC) in an open-label study. Decongestion was monitored by tracking changes in body weight. The primary endpoint was a win ratio based on a 30-day hierarchical composite of cardiovascular death, heart failure events, and changes in N-terminal pro–B-type natriuretic peptide. Secondary endpoints assessed included severity of dyspnea, functional capacity, and quality of life.

The study led to the following findings:

• Thirty-four participants were randomized to SC furosemide and 17 to UC. SC furosemide caused a greater reduction in body weight: between-group difference in least square mean change was −2.02 kg at day 3.
• SC furosemide-to-UC win ratio was 1.11.
• Significant between-group least square mean differences favoring SC furosemide occurred in 7-point dyspnea score and 6-minute walk test, with a trend in the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 Overall Summary Score of 9.15.
• The most common related adverse event with SC furosemide was mild infusion site pain (11.8%).

The findings revealed that SC furosemide led to increased weight loss in patients with heart failure and worsening congestion.

"Although the pilot study did not achieve statistical significance for its composite primary endpoint, the observed improvements in dyspnea scores, functional capacity, and a positive trend in the KCCQ-12 score suggest that further research is needed to fully assess the clinical value of SC furosemide as a potential alternative to hospitalization," the researchers concluded.

Reference:

Konstam MA, Massaro J, Dhingra R, et al. Avoiding treatment in hospital with subcutaneous furosemide for worsening heart failure: a pilot study (AT HOME-HF). JACC Heart Fail. 2024;Epub ahead of print.