The use of a continuous subcutaneous infusion of Frusemide (CSI-F) in patients with decompensated heart failure A feasibility study

Abstract

Background Heart failure is a major health and economic burden which is increasing along with the aging of populations around the world (von Lueder & Krum, 2012). It is associated with significant mortality and morbidity and interspersed with frequents hospitalisations for worsening symptoms. As symptoms of congestion progress (weight gain, peripheral oedema, and increasing breathlessness) patients are often admitted to hospital for intravenous diuretics. Subcutaneous Frusemide is seen as a possible alternative to intravenous Frusemide. The purpose of this feasibility study was to observe the effectiveness of a continuous subcutaneous infusion of Frusemide in patients with decompensated heart failure. Methods Fifteen patients with decompensated heart failure admitted to a Cardiology ward at a large tertiary hospital were recruited into the study. Patients were administered a continuous infusion of Frusemide via a syringe driver into the subcutaneous tissue in the pectoral area. Primary measures consisted of weight, 24 hour urine output, urine sodium concentration, breathlessness and peripheral oedema scores. Secondary and safety measures were changes in serum Creatinine and site reactions. Results Weight loss was achieved in all fifteen patients with the mean daily weight loss of 1.8kg. The mean 24 hour urine volume was 3151mls/24 hours. All participants experienced an improvement in breathlessness and oedema. Over the study period, all subcutaneous sites appeared healthy with no signs of infection. All but one participant reported no pain from the infusion. Conclusion Within a cardiology population of patients with decompensated heart failure, a continuous subcutaneous infusion of Frusemide is effective in achieving a diuresis and is safe and acceptable to patients.