Abstract 16820: Outpatient Intravenous Diuresis in Decompensated Heart Failure: A Systematic Review

Introduction: Heart failure (HF) burdens the US healthcare system, with persistent 30-day readmission (25%) and mortality rates (10%), and annual costs exceeding $30 billion. Outpatient intravenous (OP IV) diuresis in clinic or home settings may potentially improve outcomes and reduce costs, though limited data exist. This systematic review evaluates the safety, efficacy, and outcomes of OP IV diuresis in managing decompensated HF as a hospitalization alternative.

Methods: Following PRISMA 2020 guidelines, this systematic review used MeSH terms in MEDLINE, SCOPUS, CINAHL Complete, and Cochrane Central. From 16 selected studies, 15 were single-center; 6 prospective, 9 retrospective; and 1 was a randomized trial comparing OP IV diuresis to oral home regimen. Demographics, visit data, and outcomes were collected, and 30-day outcomes were compared to inpatient IV (IP IV) diuresis from 2021 Medicare HF hospitalizations.

Results: The review included 2088 unique patients, with a mean age of 69±6 years, 62% male, and 75% NYHA III-IV. Minimal adverse post-diuresis events such as hypokalemia, hypotension, and worsening renal function occurred (4.3%, 0.7%, and 2.2% respectively). Post-visit mean weight loss was -2.2±1.1 kg. The 30-day readmission rate for OP IV diuresis was comparable to IP IV diuresis (22.6 % vs. 22.6%; p=0.995), while 30-day mortality was lower (5.6% vs. 10.7%; p<0.001). In addition, mean 1-year mortality for OP IV diuresis was under 20%, compared to 25-30% for IP IV diuresis. Estimated cost savings per patient ranged from $1,632-10,395.

Conclusions: OP IV diuresis is a safe and effective treatment for decompensated HF with minimal risk of adverse events. Data demonstrates comparable readmission rates to IP IV diuresis with significantly lower mortality rates and costs. These findings highlight the potential of OP IV diuresis as an enhanced alternative for HF care; however, further randomized control trials are needed to evaluate long-term outcomes.