Practical outpatient management of worsening chronic heart failure

Nicolas Girerd (1, 2, 3, 4) , Nathan Mewton (5, 6, 7) , Jean‐michel Tartière (8) , Damien Guijarro (9) , Patrick Jourdain (10, 11) , Thibaud Damy (12, 13) , Nicolas Lamblin (14) , Antoni Bayes‐génis (15, 16, 17) , Pierpaolo Pellicori (18) , James Januzzi (19, 20, 21) , Patrick Rossignol (1, 2, 3, 4) , François Roubille (22, 23)

1 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
2 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
3 INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
4 Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
5 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
6 HCL - Hospices Civils de Lyon
7 CIC1407 - Centre d'Investigation Clinique [Bron]
8 Centre Hospitalier Intercommunal Toulon-La Seyne sur Mer - Hôpital Sainte-Musse
9 ITX-lab - ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
10 Covidom regional telemedicine platform
11 Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
12 Réseau cardiogen
13 CHU Henri Mondor [Créteil]
14 Pole Cardio-vasculaire et pulmonaire [CHU Lille]
15 CIBERCV - Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares
16 UAB - Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
17 IGTP - Institut d’Investigació Germans Trias i Pujol = Germans Trias i Pujol Research Institute
18 University of Glasgow
19 Massachusetts General Hospital [Boston]
20 Baim Institute for Clinical Research Boston MA
21 HMS - Harvard Medical School [Boston]
22 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
23 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]

Management of worsening heart failure (WHF) has traditionally been hospital-based, but with the rising burden of HF, the pressure on health care systems exerted by this disease necessitates a different strategy than long (and costly) hospital stays. A strategy for outpatient intravenous (IV) diuretic treatment of WHF has been developed in certain American centers in the past 10 years, whereas European centers have been mostly favoring "classic" in-hospital management of WHF. Embracing novel, outpatient approaches for treating WHF could substantially reduce the burden on healthcare systems while improving patient's satisfaction and quality of life. The present article is intended to provide essential knowledge and practical guidelines aimed at helping clinicians implement these new ambulatory approaches using day hospital and/or at-home hospitalization. The topics addressed by our group of HF experts include the pathophysiological background of diuretic therapy, the most suitable profile of WHF that may be managed in an ambulatory setting, the pharmacological protocols that can be used, as well as a detailed description of healthcare structures that can be proposed to deliver these ambulatory care interventions. The practical aspects of day hospital and Hospital-at-Home (HaH) IV diuretics administration are specifically emphasized. The algorithm provided along with the practical IV diuretics protocols should assist HF clinicians in implementing this new approach in their local clinical setting.

Domaines: Sciences du Vivant [q-bio]

Nicolas Girerd, Nathan Mewton, Jean‐michel Tartière, Damien Guijarro, Patrick Jourdain, et al.. Practical outpatient management of worsening chronic heart failure. European Journal of Heart Failure, inPress, ⟨10.1002/ejhf.2503⟩. ⟨hal-04277795v1⟩