Torsemide and furosemide show no significant difference in all-cause mortality in HF patients: JAMA
USA: A recent Clinical Trial called TRANSFORM-HF, published in JAMA, has found that torsemide and furosemide, two commonly used loop diuretics for heart failure patients, have similar outcomes when it comes to all-cause mortality.
Loop diuretics are medications used to manage and treat fluid overload conditions such as heart failure, nephrotic syndrome, cirrhosis, and hypertension. They stimulate the synthesis of prostaglandins which leads to the dilation of the renal and venous systems. This mechanism helps to account for certain cardiac effects, including a decrease in pulmonary wedge pressure.
TRANSFORM-HF, an open-label, pragmatic randomized trial, recruited 2859 participants hospitalized with heart failure at 60 hospitals in the United States. The study's participants were randomized to receive either torsemide or furosemide, with their dosage selected by the investigator.
Of the 2859 participants, 1431 were assigned to the torsemide group, and 1428 were assigned to the furosemide group.
The study revealed the following key clinical takeaways:
- The study found that death occurred in 26.1% of patients in the torsemide group and 26.2% of patients in the furosemide group.
- The study found that over 12 months following randomization, all-cause mortality or all-cause hospitalization occurred in 47.3% of patients in the torsemide group and 49.3% of patients in the furosemide group.
- There were 940 total hospitalizations among 536 participants in the torsemide group and 987 total hospitalizations among 577 participants in the furosemide group.
The findings revealed that torsemide compared with furosemide, did not significantly affect all-cause mortality over 12 months.
The study's interpretation of the findings is limited by loss to follow-up and participant crossover and non-adherence. The results were similar across prespecified subgroups, including patients with reduced, mildly reduced, or preserved ejection fraction.
The study's lead author, Dr Robert Mentz, added, “Important insights into the use of loop diuretics in heart failure patients suggest that both torsemide and furosemide can be effective in managing heart failure symptoms. However, more research is needed to understand each medication's potential benefits and drawbacks fully.”
Reference:
Mentz RJ, Anstrom KJ, Eisenstein EL, et al. Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure: The TRANSFORM-HF Randomized Clinical Trial. JAMA. 2023;329(3):214–223. doi:10.1001/jama.2022.23924
