Subcutaneous furosemide for the treatment of heart failure: a state-of-the art review

  • Maxwell Eyram AfariEmail author
  • Joe Aoun
  • Sarthak Khare
  • Lana Tsao


The prevalence of heart failure (HF) is on the rise. By 2030, over eight million Americans (46% increase from current prevalence) will have heart failure. In the USA, approximately 30 billion dollars is spent annually on heart failure and this number will likely double in 2030. Thus, HF represents a significant economic burden. Acute decompensated heart failure (ADHF) is a clinical spectrum, which refers to increasing symptoms and signs of heart failure prompting an emergency room visit or hospitalization. In ADHF, inpatient administration of intravenous diuretic is the standard of care due to the variability in the absorption of oral diuretics. Within 30 days, 25–30% of these patients are readmitted with recurrent ADHF. Recent efforts have focused in reducing HF readmission, and thereby decreasing costs; hence, innovative outpatient treatment options have emerged. Subcutaneous furosemide use will potentially overcome the need to place intravenous lines, reduce associated expenses, and enable management of ADHF at home. This review presents data on the pharmacodynamics and pharmacokinetics of subcutaneous furosemide, scientific evidence on the use of this therapy in the palliative and hospice population, and its experimental use as an outpatient therapy and/or as a bridge from inpatient to home.


Subcutaneous Furosemide Heart failure At-home treatment Palliative care 


Compliance with ethical standards

This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

None of the authors has any conflict of interest related to the contents of this manuscript. Lana Tsao has received research grant from SC Pharmaceuticals Inc. (developers of the proprietary furosemide infusor) for an ongoing clinical trial. None of the coauthors have any disclosures to make.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Cardiovascular MedicineSt. Elizabeth’s Medical Center/ Tufts University School of MedicineBrightonUSA
  2. 2.Department of MedicineSt Elizabeth’s Medical Center/ Tufts University School of MedicineBrightonUSA

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