Community-based intravenous diuretic therapy delivered through a collaborative heart failure and community paramedic model: a real-world service evaluation
C Farrell, G Gardiner, C Kelly, K Mccafferty, M Collins, M Conlon, G Ryan, K Mason, E Mcglynn, R Greene, A Odonnell, M Ojeda RamosAbstract
Abstract
Hospital admission for decompensated heart failure (HF) is associated with poor outcomes and healthcare burden. Community-based intravenous (IV) diuretic therapy may facilitate decongestion while avoiding emergency department (ED) attendance. We evaluated outcomes of a collaborative HF specialist and community paramedic IV diuretic service.
Methods
We performed a prospective service evaluation of patients with worsening HF treated with IV loop diuretics in the community between December 2024 and November 2025. Patients were assessed by the HF team via face-to-face or virtual consultation. Community paramedics delivered IV diuretics under protocol with HF oversight. Outcomes included weight change, renal function, NT-proBNP, ED avoidance, and adverse events.
Results
Nineteen IV diuretic episodes were delivered to 12 patients (mean age 78.3 years). Baseline mean eGFR was 37.1 mL/min and mean NT-proBNP was 6620 pg/mL, reflecting a high-risk cohort. Mean IV diuretic duration was 3.1 days with doses of 40–100 mg furosemide daily. Mean weight reduction was 1.85 kg with accompanying reductions in NT-proBNP where measured. Renal function remained stable (mean post-treatment eGFR 35.9 mL/min). ED attendance was avoided in 84% of episodes. Hospital admissions were due to non-HF causes, with no HF-related admissions during IV therapy. One episode of hypokalaemia occurred; no treatment-related acute kidney injury was observed.
Conclusion
Community-delivered IV diuretic therapy using a collaborative HF and community paramedic model is feasible, safe, and effective in a high-risk HF population. This approach achieves meaningful decongestion while substantially reducing ED attendance and hospital admission, supporting wider adoption of integrated community HF services.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.