Optimizing outpatient management of heart failure: the role of a diuretic day hospital in cardio-geriatrics

Abstract Introduction Heart failure (HF) is a highly prevalent chronic condition associated with significant hospitalization and mortality rates, affecting over 10% of the elderly population. Full hospitalization (FH) in older patients carries substantial risks. A more appropriate outpatient approach is essential. A diuretic day hospital (DH) was established at Hôpital La Porte Verte to manage patients with decompensated HF without hospitalization. Patients are seen in the DH, where they are assessed by the coordinating nurse (CN) and a cardiogeriatrician, who determines the appropriate diuretic dosage. The CN administers the infusion, delivers the diuretic bolus, and arranges the patient's return home with either home hospitalization (HH) or a home care provider (HCP). Patients are reassessed a few days later. If outpatient management becomes insufficient, direct FH admission is available. Materials and Methods This is an observational, descriptive, single-center study conducted at the diuretic DH from January 1 to 31, 2025. The study includes all patients over 70 years old admitted to the DH for decompensated HF. The study aims to (i) characterize the patient profile benefiting from diuretic DH and (ii) describe the organizational structure of the diuretic DH pathway. Results Eight patients were included, with a mean age of 84.7 ± 6.5 years; 62.5% were women. The average Activities of Daily Living (ADL) score was 5.4/6 ± 0.5. Two patients were institutionalized in nursing homes, and one lived alone at home. Two patients (25%) were referred by their general practitioner, one (12.5%) via HF telemonitoring, one (12.5%) from the emergency department, two (25%) from the hospital's geriatric DH, and two (25%) from an iron IV HF DH visit due to unexpected HF decompensation. The average time to DH admission after referral was 1.1 ± 1.7 days. No patient required FH admission. Five patients (62.5%) returned home with an HCP, while three (37.5%) required HH for IV diuretics. Three patients (37.5%) required oxygen therapy. Patients received an average of 226.3 ± 67.2 mg of IV furosemide per DH session. Upon discharge, they continued with an average of 342.9 ± 150.2 mg/day IV. The mean number of diuretic DH sessions needed to complete treatment was 3.2 ± 1.96, with a total decongestion duration averaging 7.7 ± 6.7 days. Complications managed in outpatient settings included one case (12.5%) of hyperkalemia, one (12.5%) of hypokalemia, and two (25%) of functional acute kidney injury. Two patients (25%) were newly enrolled in HF telemonitoring via Satelia Cardio, while three (37.5%) were already monitored. Conclusion Implementing an outpatient care pathway for HF is crucial, particularly in geriatrics, where FH presents risks. The diuretic DH effectively manages these patients, reducing hospital-related iatrogenic complications. Continued enrollment in the diuretic DH is necessary to further evaluate this care model and expand data on its role in HF management.