title: Outpatient intravenous diuretic therapy; potential for marked reduction in hospitalisations for acute decompensated heart failure.
abstract: BACKGROUND
  Heart failure patients have frequent readmissions for acute decompensated heart failure (ADHF).
  
  
  OBJECTIVE
  To examine the feasibility, safety and outcomes of outpatient intravenous (IV) diuretic therapy in treating ADHF.
  
  
  METHODS
  A retrospective analysis was performed of all patients included in a hospital-based heart failure disease management programme, who received outpatient IV diuretic therapy for the management of ADHF between 2002 and 2006. Changes in clinical and biochemical parameters from time of therapy to stability were measured.
  
  
  RESULTS
  One hundred and seven patients (mean age 71+/-11 years) received outpatient IV diuretic therapy for ADHF IV diuretic administration reduced weight (p<0.001), blood pressure (p<0.01) and BNP (p=0.01). It increased urea (p=0.01) and creatinine (p=0.07). Seventy-two percent of patients stabilised following IV diuretics and did not require admission. No patients were hospitalised for hypotension or hypokalaemia. One patient was hospitalised for renal failure. Two patients died post admission.
  
  
  CONCLUSIONS
  Outpatient IV diuretic administration for ADHF is safe, cost effective and reduces hospitalisations. This service may expand the potential of a disease management programme to manage ADHF out of hospital and thereby reduce the hospital dependency of this condition.
authors.affiliation: Heart Failure Unit, Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Ryder
authors.forename: Niamh F
authors.initials: NF
authors.lastname: Murphy
authors.forename: Dermot
authors.initials: D
authors.lastname: McCaffrey
authors.forename: Christina
authors.initials: C
authors.lastname: O'Loughlin
authors.forename: Mark
authors.initials: M
authors.lastname: Ledwidge
authors.forename: Kenneth
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D004232:Diuretics / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies
chemical_list: D004232:Diuretics