Treating worsening heart failure with an ambulatory service
In England, a heart failure service was introduced to provide intravenous diuretics to people with a worsening heart failure episode.
Risk stratification ensured that those with lower risk received the ambulatory service at home, while people considered high risk were directed to the day centre. The care team included cardiologists and heart failure specialist nurses. The home visit allowed monitoring of signs and symptoms and the data were shared with the hospital, allowing the continuation, escalation or discontinuation of intravenous diuretics according to the data received.
Most of the worsening heart failure episodes were managed by the ambulatory service without complications. Only 20% of people required hospital admission to receive higher doses of treatment. Importantly, the service achieved a significant reduction in mortality compared with hospital admission.
Ahmed FZ, Taylor JK, John AV, et al. 2021. Ambulatory intravenous furosemide for decompensated heart failure: safe, feasible, and effective. ESC Heart Fail 8(5): 3906-16