SPC365

Home intravenous diuretics: a way to reduce hospital bed usage and urgent admissions

Session: Comunicações Orais - Sessão 08 - Insuficiência cardíaca: da clínica aos dispositivos
Speaker: ANGELA MARGARIDA MARTINS DE CASTRO

Congress: CPC 2024
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Margarida De Castro; Mariana Tinoco; Filipa Cardoso; Luísa Pinheiro; Tamara Pereira; Mónica Rebelo; Pedro Gomes; Bebiana Faria; João Português; Filipa Almeida; António Lourenço
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">Introduction:</span></span></strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT"> Heart failure (HF) is often associated with clinical decompensations for volume overload leading to frequent hospitalizations, deterioration of prognosis and high healthcare costs. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">HF clinics are an effective way for administering IV diuretics in a day-unit setting for ambulatory patients (pts). However, this regimen can be inadequate to advanced end-staged HF pts, dependent on IV diuretics.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">In our hospital, a program called &ldquo;home support mobile unit&rdquo; (HSMU) was implemented to support administration of continuous IV diuretics at the patient&acute;s home, with the assistance of a differentiated nursing team to improve management of fluid retention, pts&#39; quality of life, and reduce readmissions. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">Aim:</span></span></strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT"> To describe our experience with HSMU for IV diuretic administration and to evaluate safety and effectiveness in reducing urgent visits and hospitalizations for decompensated HF (DHF).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">Methods</span></span></strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">: Retrospective study including pts who received IV diuretics at home through HSMU between May 2018 and Nov&nbsp;2023. Pts were proposed for HSMU by the cardiologist and HF specialist in the presence of recurrent admission due to DHF, dependence of IV diuretics, persistent NYHA class III-IV and not candidate to heart transplant. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">Continuous diuretic IV infusions were administrated through a long lasting peripheral catheter. At least one weekly visit by a nurse team was performed. Clinical status, vital signs and weight were routinely accessed and communicated to the cardiologist. Medical appointments and blood tests were performed as necessary. All data were collected in pts&#39;&nbsp;electronical records. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">Results: </span></span></strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">We included 21 pts. Data characterizing this population is presented in table 1. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">The median length of stay at HSMU was 57 (IQR15-150) days with a median of 19 (IQR6-70) team visits performed. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">The majority of pts received IV diuretics through continuous infusion (90,5%;n=19). Median cumulative IV dose was 190 (IQR110-230) mg per day. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">No major complications were reported. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">A significant reduction in HF hospitalizations was noted after entry into HSMU - 4 (IQR2-6) in the previous year <em>vs</em> 1 (IQR1-2) during program, <em>p</em>&lt;0.001) as well as urgent HF visits &ndash; 4 (IQR3-10) <em>vs</em> 1 (IQR1-2), <em>p</em>&lt;0.001). Median time for first hospitalization after HSMU was 3.5 (IQR4-9) months and for first HF visit was 2 (IQR 1-9) months. Cardiovascular mortality was 95,2% (n=20). There were no significant differences in the NYHA class neither in the BNP, sodium and potassium levels during treatment. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">Conclusion: </span></span></strong><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">This is, to our knowledge, one of the first programs to allow administration of IV diuretic therapy, including by continuous infusion, at home. </span></span></span></span><span style="font-size:11.5pt"><span style="font-family:TimesNewRomanPSMT">Despite the challenges encountered and recognizing the relatively small number of pts enrolled, this program has demonstrated that diuretic therapy can be delivered safely and effectively in the home health setting and can improve pts experience outcomes while reducing readmissions.</span></span></p>