James Udelson, MD: Subcutaneous Furosemide for Diuresis Outside of the Hospital

James Udelson MD: We've been doing some work with SC Pharma, the company developing subcutaneous furosemide infusions. I think that ultimately, it could be something that's really useful for patients, and really useful for providers of all types - physicians, nurses, etc. - because it provides a way to give what is essentially, and that provides the same furosemide levels and action as, an intravenous dose without having to start an IV and to monitor the patient in the clinic. There are many instances around the country of people starting diuresis clinics, where patients who are starting to drift downward and become more congested may not be responding to a boost in their oral therapy, come in they get an intravenous line started they get a dose of IV furosemide. They wait around 5-6 hours to make sure they peed and that they're feeling better, and then they go home. They might come back a day or two later for another one.

This way, with the device that's being developed, once you educate the patient how to use it, you sort of plug it on, subcutaneous injection, and there's now been a couple of studies showing that you get equivalent levels to an intravenous dose and equivalent urine output. You could prescribe that for 1 day or several days in a row, keep in touch with the patient, and it provides a way to essentially use the same the same action as intravenous not having an intravenous line and being in a clinic or in a hospital. If you have an outpatient diuresis clinic, you don't have to start an IV and watch the patient for several hours and have them back. It all gets done essentially at home once you teach the patient how to use the device, so from a clinic perspective that's something.

In theory, if someone presents to an emergency room with sort of low-risk, decompensated heart failure without many other things going on, in theory, you could see if they're responding to 1 dose in the emergency room and then send them home and not admit them. You're essentially treating them with 2 or 3 days of the equivalent of intravenous furosemide IV rather than admitting them. So from a patient perspective, maybe you can avoid hospitalizations, either from the kind of patient is worsening as an outpatient or potentially the kind of patient who's being seen in an emergency department.