Outpatient treatment of decompensated heart failure: A systematic review and study level meta‐analysis
Abstract Patients with acutely decompensated heart failure (ADHF) are usually admitted to hospital for management. There is growing interest in delivering intravenous (IV) diuretic therapy at home, in the community or at hospital day‐care units; the safety and effectiveness of outpatient‐based manag...
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| Format: | Article |
| Language: | English |
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Wiley
2025-04-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.14841 |
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| author | Jameela Bahar Amna Rahman Grace W.Y. Wong Rajiv Sankaranarayanan Fozia Z. Ahmed Rebecca Taylor Ahmet Fuat Iain Squire John G.F. Cleland Gregory Y.H. Lip James H.P. Gamble Sundas Masudi Prince Josiah S. Joseph Kenneth Y.K. Wong |
| author_facet | Jameela Bahar Amna Rahman Grace W.Y. Wong Rajiv Sankaranarayanan Fozia Z. Ahmed Rebecca Taylor Ahmet Fuat Iain Squire John G.F. Cleland Gregory Y.H. Lip James H.P. Gamble Sundas Masudi Prince Josiah S. Joseph Kenneth Y.K. Wong |
| author_sort | Jameela Bahar |
| collection | DOAJ |
| description | Abstract Patients with acutely decompensated heart failure (ADHF) are usually admitted to hospital for management. There is growing interest in delivering intravenous (IV) diuretic therapy at home, in the community or at hospital day‐care units; the safety and effectiveness of outpatient‐based management (OPM) for ADHF has not been established. We conducted a systematic literature review and meta‐analysis to investigate the short‐term safety and effectiveness of OPM compared with inpatient management (IPM) of ADHF. Pre‐specified endpoints were 30 day mortality and 30 day hospitalization. The meta‐analysis was conducted using RevMan 5.4 software. Twenty‐nine studies of OPM were identified, including 7683 patients. Only five studies directly compared OPM (n = 1303) with IPM (n = 2047), including three observational studies, and two randomized controlled trials (RCTs). The other 24 studies only stated OPM outcomes. For the five studies comparing IPM versus OPM, patients were generally aged >75 years and of similar age for each strategy, with a similar proportion of men (56%). In a study‐level, aggregate analysis, 30 day all‐cause mortality was 9.3% (121/1303) for OPM, compared with 15.6% (320/2047) for IPM [OR 0.29 (95% CI 0.09, 0.93) P = 0.04]. Four studies reported 30 day all‐cause hospitalization; 22.0% for IPM versus 16.8% for OPM [OR 0.73 (95% CI 0.61, 0.89), P = 0.001]. In the two RCTs, we found no difference in 30 day mortality or hospitalization. In observational studies, OPM of ADHF is associated with lower 30 day hospitalization and lower 30 day mortality; such differences were not observed in two small, single‐centre RCTs. A substantial, multicentre RCT is required to confirm the safety and effectiveness of OPM for ADHF. |
| format | Article |
| id | doaj-art-d9cb031890f64fe782983a88211d40eb |
| institution | DOAJ |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-d9cb031890f64fe782983a88211d40eb2025-08-20T03:01:47ZengWileyESC Heart Failure2055-58222025-04-0112276176910.1002/ehf2.14841Outpatient treatment of decompensated heart failure: A systematic review and study level meta‐analysisJameela Bahar0Amna Rahman1Grace W.Y. Wong2Rajiv Sankaranarayanan3Fozia Z. Ahmed4Rebecca Taylor5Ahmet Fuat6Iain Squire7John G.F. Cleland8Gregory Y.H. Lip9James H.P. Gamble10Sundas Masudi11Prince Josiah S. Joseph12Kenneth Y.K. Wong13Department of Cardiology, Lancashire Cardiac Centre Blackpool UKDepartment of Cardiology, Lancashire Cardiac Centre Blackpool UKLancashire Cardiac Centre Patient Public Involvement Group, Lancashire Cardiac Centre Blackpool Teaching Hospitals NHS Foundation Trust Blackpool UKLiverpool University Hospitals NHS Foundation Trust Liverpool UKKeele University, Keele Cardiovascular Research Group Keele UKDepartment of Cardiology, Lancashire Cardiac Centre Blackpool UKDurham University UKNIHR Cardiovascular Research Centre Glenfield Hospital Leicester UKBritish Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health University of Glasgow Glasgow UKLiverpool Centre for Cardiovascular Science at University of Liverpool Liverpool John Moores University and Liverpool Heart and Chest Hospital Liverpool UKOxford Heart Centre John Radcliffe Hospital Oxford UKDepartment of Cardiology, Lancashire Cardiac Centre Blackpool UKDepartment of Cardiology, Lancashire Cardiac Centre Blackpool UKDepartment of Cardiology, Lancashire Cardiac Centre Blackpool UKAbstract Patients with acutely decompensated heart failure (ADHF) are usually admitted to hospital for management. There is growing interest in delivering intravenous (IV) diuretic therapy at home, in the community or at hospital day‐care units; the safety and effectiveness of outpatient‐based management (OPM) for ADHF has not been established. We conducted a systematic literature review and meta‐analysis to investigate the short‐term safety and effectiveness of OPM compared with inpatient management (IPM) of ADHF. Pre‐specified endpoints were 30 day mortality and 30 day hospitalization. The meta‐analysis was conducted using RevMan 5.4 software. Twenty‐nine studies of OPM were identified, including 7683 patients. Only five studies directly compared OPM (n = 1303) with IPM (n = 2047), including three observational studies, and two randomized controlled trials (RCTs). The other 24 studies only stated OPM outcomes. For the five studies comparing IPM versus OPM, patients were generally aged >75 years and of similar age for each strategy, with a similar proportion of men (56%). In a study‐level, aggregate analysis, 30 day all‐cause mortality was 9.3% (121/1303) for OPM, compared with 15.6% (320/2047) for IPM [OR 0.29 (95% CI 0.09, 0.93) P = 0.04]. Four studies reported 30 day all‐cause hospitalization; 22.0% for IPM versus 16.8% for OPM [OR 0.73 (95% CI 0.61, 0.89), P = 0.001]. In the two RCTs, we found no difference in 30 day mortality or hospitalization. In observational studies, OPM of ADHF is associated with lower 30 day hospitalization and lower 30 day mortality; such differences were not observed in two small, single‐centre RCTs. A substantial, multicentre RCT is required to confirm the safety and effectiveness of OPM for ADHF.https://doi.org/10.1002/ehf2.14841outpatient IV diureticsacute decompensated heart failuresystematic reviewmeta‐analysis |
| spellingShingle | Jameela Bahar Amna Rahman Grace W.Y. Wong Rajiv Sankaranarayanan Fozia Z. Ahmed Rebecca Taylor Ahmet Fuat Iain Squire John G.F. Cleland Gregory Y.H. Lip James H.P. Gamble Sundas Masudi Prince Josiah S. Joseph Kenneth Y.K. Wong Outpatient treatment of decompensated heart failure: A systematic review and study level meta‐analysis ESC Heart Failure outpatient IV diuretics acute decompensated heart failure systematic review meta‐analysis |
| title | Outpatient treatment of decompensated heart failure: A systematic review and study level meta‐analysis |
| title_full | Outpatient treatment of decompensated heart failure: A systematic review and study level meta‐analysis |
| title_fullStr | Outpatient treatment of decompensated heart failure: A systematic review and study level meta‐analysis |
| title_full_unstemmed | Outpatient treatment of decompensated heart failure: A systematic review and study level meta‐analysis |
| title_short | Outpatient treatment of decompensated heart failure: A systematic review and study level meta‐analysis |
| title_sort | outpatient treatment of decompensated heart failure a systematic review and study level meta analysis |
| topic | outpatient IV diuretics acute decompensated heart failure systematic review meta‐analysis |
| url | https://doi.org/10.1002/ehf2.14841 |
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