Loop Diuretics in Heart Failure: Torsemide and furosemide equally effective regardless of HF type

A recent post hoc analysis of the TRANSFORM-HF trial explored the clinical profiles and outcomes of heart failure (HF) patients treated with torsemide versus furosemide, focusing on differences between de novo HF and worsening chronic HF (WHF). This study was published in JAMA Cardiology by Selim R. and colleagues.

The study included 2,858 patients with documented ejection fraction, revealing that 838 patients had de novo HF, and 2,020 had WHF. Noteworthy distinctions were observed, with de novo HF patients being younger, having a higher glomerular filtration rate, lower natriuretic peptide levels, and receiving lower doses of loop diuretics compared to WHF patients.

De novo HF was associated with lower all-cause mortality at 12 months (9.1% vs. 25.4% in WHF).

Patients with de novo HF exhibited lower all-cause first rehospitalization rates and greater improvement in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score at 12 months.

Torsemide and furosemide showed no significant difference in mortality, hospitalization rates, or total hospitalizations at 12 months for both de novo HF and WHF.

The analysis concludes that patients with de novo HF experience better clinical and patient-reported outcomes compared to those with WHF. Additionally, the choice between torsemide and furosemide did not significantly impact clinical or patient-reported outcomes over the 12-month period, irrespective of HF type.

This study sheds light on the nuanced differences in HF presentations and emphasizes the need for tailored treatment approaches based on HF type. The findings underscore the comparable effectiveness of torsemide and furosemide in managing HF, providing clinicians with valuable insights into optimizing diuretic strategies for improved patient outcomes.

Reference:

Krim, S. R., Anand, S., Greene, S. J., Chen, A., Wojdyla, D., Vilaro, J., Haught, H., Herre, J. M., Eisenstein, E. L., Anstrom, K. J., Pitt, B., Velazquez, E. J., & Mentz, R. J. Torsemide vs furosemide among patients with new-onset vs worsening chronic Heart Failure: A substudy of the TRANSFORM-HF randomized clinical trial. JAMA Cardiology,2023. https://doi.org/10.1001/jamacardio.2023.4776