2026 Eastern States Conference

Title: Evaluation of subcutaneous furosemide prescribing patterns and perceptions among cardiology providers in patients with heart failure

Authors: Ashley Mayes, PharmD, MPH, Keturah DelGrosso, PharmD, BCPS, Danielle Karaffa, PharmD, BCPS, Michael DiMaggio, PharmD Sarah Krahe Dombrowski, PharmD, BCACP

Learning Objective: Identify potential barriers and knowledge gaps influencing the use of subcutaneous (SQ) furosemide in the ambulatory cardiology setting for patients with heart failure (HF).

Self-Assessment Question: Potential barriers of SQ furosemide use in the ambulatory setting include insurance or prior authorization issues, out-of-pocket expense to patients, and concerns surrounding patient self-administration (True/False)

Background: Subcutaneous (SQ) furosemide is an alternative to IV furosemide for HF exacerbation due to equal bioavailability and ambulatory administration. This study examined cardiology provider perceptions of SQ furosemide in ambulatory HF patients.

Methods: This retrospective mixed-methods analysis was conducted via Epic SlicerDicer and surveys distributed to Geisinger cardiology providers and cardiology pharmacists.  Epic SlicerDicer was utilized to identify patients with active SQ furosemide prescriptions as well as those who may have been potential candidates for SQ furosemide based on a proposed high-risk criteria. Survey participants received an email with an overview of the project, education regarding SQ furosemide, and the survey link as well as a reminder email at 7 and 14 days. The survey was open from 3/3/2026 to 3/20/2026. Multiple choice, select all that apply, ranking, Likert-type and open-ended questions were utilized to identify clinical perceptions and potential barriers of SQ furosemide prescribing in the outpatient cardiology setting as well as gather provider insight on appropriate patient selection criteria for SQ furosemide use.  Data was anonymously collected via Microsoft Forms and analyzed via Microsoft Excel.

Results: Preliminary analysis of quantitative data revealed that that of 94,833 adult patients with HF at Geisinger, 23 had an active prescription for SQ furosemide between 10/10/22-10/1/25. Of those with HF, 3,079 were on a maintenance oral loop diuretic regimen of ≥ 40 mg furosemide daily or equivalent AND had at least 1 hospitalization or emergency department (ED) visit for HF within the past 6 months OR were administered an IV loop diuretic for HF within the past 6 months - indicating that they could potentially benefit from SQ furosemide. The survey was sent to 128 participants and received 13 (10.2%) responses. Qualitative survey results are currently being analyzed and results will be reported at the conference.  

Conclusion: Survey results showed most providers have positive clinical perceptions of SQ furosemide and find it at least somewhat beneficial for outpatient management of HF exacerbation.  A major perceived barrier to SQ furosemide prescribing identified was cost concern.  Given the positive response from clinicians, a subsequent cost analysis of SQ furosemide versus alternatives was presented to pharmacy leadership for potential implementation.