Subcutaneous Furosemide Enabled Earlier Heart Failure Discharge and Increased Days Alive

An early discharge strategy using subcutaneous furosemide delivered via a wearable, patient-operated minipump increased days alive and out of hospital (DAOH) at 30 days compared with usual care in patients hospitalized for heart failure, according to results of the SUBCUT-HF II trial published in the Journal of the American College of Cardiology.

The multicenter, open-label, randomized, active-controlled trial enrolled 172 patients at 20 hospitals in Scotland and England who required ongoing parenteral diuretics, including an expected need for intravenous furosemide for at least 24 hours after screening and an N-terminal pro-B-type natriuretic peptide level >300pg/mL. Patients assigned to early discharge (n=92) received a pH-neutral subcutaneous furosemide formulation (Lasix ONYU) containing 80mg in 2.7mL, via a minipump attached to the abdominal wall, with nurse review every 3 ± 1 days until euvolemia, when they were prescribed an oral diuretic. Patients in the usual care group (n=80) continued inpatient treatment with intravenous furosemide.

The early discharge strategy resulted in 4.0 more DAOH at 30 days, the primary outcome (95% CI, 2.1-5.8; P<0.001). Index hospitalization was shorter by a mean of 5.5 days, and the DAOH benefit persisted at 60 days (difference, 4.2 days; 95% CI, 0.9-7.6). Investigators reported no difference in health status between groups, as measured by the Kansas City Cardiomyopathy Questionnaire-12.

Heart failure readmissions were numerically more frequent in the early discharge group (14% vs 6%; odds ratio, 2.45; 95% CI, 0.81-7.43). Serious adverse events occurred in 25% and 23% of patients, respectively. Device-related problems occurred with 3% of 1,054 subcutaneous furosemide doses, none of which resulted in a serious adverse event.

The authors cautioned against applying the strategy to other populations, noting that the trial was conducted only in Scotland and England, was not blinded, and was not powered to exclude uncommon but serious safety events. 

Source: Campbell RT, Osmanska J, Docherty KF, et al. Early discharge strategy including subcutaneous furosemide in hospitalized heart failure. J Am Coll Cardiol. 2026;88(15):1781-1793. doi:10.1016/j.jacc.2026.07.047