Home Administration of Intravenous Diuretics in Heart Failure (HAVEN-HF) Study
Bibliographic record
Abstract
Background: Heart failure (HF) is a leading cause of hospitalization among individuals over 65 years of age and a major contributor to 30-day readmission in Ontario. Diuretics are essential for managing congestion, relieving symptoms, and preventing hospitalization. Home administration of intravenous (IV) furosemide offers a strategy for select HF patients to manage worsening symptoms and avoid acute care utilization. While international studies have demonstrated its feasibility, safety and efficacy, understanding of home IV diuretic implementation in Ontario remains limited. Objective: The HAVEN-HF (Home Administration of intraVENous diuretics in Heart Failure) study aimed to explore the current practices and implementation experiences of home IV furosemide therapy in Ontario. Objectives were to describe existing programs and identify key barriers and facilitators influencing service delivery from the perspectives of healthcare providers, including physicians, nurse practitioners, nurses, and community paramedics. Methods: A qualitative descriptive study design used semi-structured interviews with 19 healthcare professionals involved in prescribing, coordinating, or administering home IV furosemide across Ontario. Interviews were guided by the Gorski Model for Safe Home Infusion and the Consolidated Framework for Implementation Research (CFIR), and results were analyzed using thematic analysis utilizing the Framework Method. Results: Major themes emerged including: (1) variability in patient selection and eligibility practices, (2) challenges in homecare system readiness, (3) fragmented communication among prescribers, homecare services, and community paramedics, (4) complexity in patient and caregiver education, and (5) inconsistent assessment, monitoring, and administration practices. Barriers included resource limitations, gaps in provider competencies, lack of real-time communication, and inconsistent organizational structures. Facilitators included strong interprofessional relationships, patient engagement in self-monitoring, flexible adaptation of home IV furosemide models to local needs, and designated communication pathways. Home IV furosemide was most often administered to avoid hospitalization or support symptom management in palliative care. Conclusions: Home IV diuretic administration in Ontario requires coordinated infrastructure, interprofessional collaboration, and system-level supports. Findings from the HAVEN-HF study highlight the need for standardized eligibility criteria, assessment and monitoring protocols, provider competencies, and integrated communication pathways. Aligning these elements with broader system frameworks could support the safe and effective expansion of home-based HF care in Ontario.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".