My name is Ross Campbell. I’m a cardiologist and senior clinical lecturer at the University of Glasgow and the Queen Elizabeth University Hospital in Glasgow.

Many patients are admitted to hospital with worsening heart failure and require treatment with intravenous diuretics. These patients are admitted very frequently, and their hospital stays are often long. Patients would often prefer to be managed outside of a hospital bed, ideally in their own home. The challenge is delivering parenteral diuretics in that environment.

This is where this innovation comes in. We can deliver subcutaneous furosemide to patients and enable them to administer their own treatment.

This was a multicentre randomised controlled trial comparing standard care—where patients were managed in hospital with intravenous diuretics—to an early supported discharge strategy using a novel mini-pump and subcutaneous furosemide.

We included patients who were primarily admitted with worsening heart failure and who had an ongoing requirement for intravenous diuretics.

The mini-pump device has been designed for patients to assemble and administer themselves after appropriate training. Patients applied the pump to their own abdomen in over 90% of cases.

The primary outcome was the number of days spent alive and out of hospital. This is an important measure because it captures not only the length of the initial hospital stay but also any readmissions or deaths during the follow-up period.

The key finding was that, with an early supported discharge strategy, patients spent more days alive and out of hospital.

We also assessed several secondary endpoints. We observed a reduction in the length of the index hospitalisation. There was no difference in patient-reported outcomes as measured by the Kansas City Cardiomyopathy Questionnaire. There was a numerically higher number of heart failure rehospitalisations; however, at 60-day follow-up, the benefit in days alive and out of hospital was maintained.

The safety profile was very favourable. There were adverse events in both treatment arms, as expected in a multimorbid elderly population admitted with heart failure. However, there was no difference in serious adverse events between the two strategies, and no difference in adverse events of special interest.

We also evaluated the safety of the device itself. There were over 1,000 applications of the device, with more than 90% applied by patients themselves. Despite this, device-related adverse events were extremely rare, and there were no serious adverse events related to device use.

Overall, our trial demonstrates that this patient-led approach, using subcutaneous furosemide delivered via a mini-pump, offers a favourable safety profile and represents a viable, more comfortable alternative to conventional inpatient care for patients with worsening heart failure.

There are, of course, regulatory processes required for the drug to become a licensed medicinal product in Europe. While the formulation already has FDA approval in the United States, further regulatory steps are needed in Europe. The device itself has received CE marking.