Bertram Pitt, MD: Subcutaneous Furosemide Cutting Down on Hospital Readmission for HF Patients

Bertram Pitt, MD: I think it's pretty clear that when you get into the hospital for heart failure, the reason is, for the most part, that you become resistant to, or non-responsive to, oral diuretics. Otherwise, you shouldn't be there if you could, for the most part, handle this with an increase in the oral diuretics, which you should do at home. But, a lot of people just get to the point where it's been over a month or two, and they've put on so much fluid in their legs, and have dyspnea, they can't lie flat, they're short of breath, and they're very uncomfortable - and they need diuresis and so they get IV diuresis.

So the idea of subcutaneous [diuresis] is to mimic what you can do with an IV, but do it outside the hospital, or maybe even augment the hospital stay to make it shorter. We see, and it's still very early, that the pump has been tested and they can give 80 mg of furosemide subcutaneously over about 5 hours. From the initial studies that have been done, it gives about the same concentration of furosemide as IV up to about 120 mg. When you give it through IV there are peaks, and those peaks are over the threshold. And if you're over the threshold, it's wasted. So the actual amount of furosemide that you're giving that works is pretty equivalent whether IV or subcutaneous. So you should be able to accomplish what you do in the hospital, outside.

A lot of the readmissions are not for heart failure, but some are, and we think we could reduce some of those that are due to fluid overload by a strategy of giving the subcutaneous when they go home, to the appropriate people. We have to make sure we don't give it to people who are volume depleted, but that we take this large fraction - maybe it's not 80% but that's what they saw in a small study - and we could give it to them and reduce their volume and get them truly euvolemic. Then, there would be fewer people bouncing back [into the hospital].