Torsemide as good as furosemide for treating de novo, chronic heart failure

Among patients with heart failure (HF), those who have de novo HF have better outcomes than those who have worsening chronic HF status, but treatment with torsemide yields 12-month outcomes that are similar to that observed with furosemide regardless of HF type, according to a post hoc analysis of the TRANSFORM-HF trial.

The study included 2,858 patients (mean age 64.5 years, 63.1 percent men) who had been randomly assigned to receive torsemide or furosemide, of whom 838 (29.3 percent) had de novo HF and 2,020 (70.7 percent) had worsening chronic HF.

Study endpoints included all-cause mortality and hospitalization outcomes over 12 months, as well as change from baseline in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS).

Compared with patients with worsening chronic HF, those with de novo HF tended to be younger, have a higher glomerular filtration rate, have lower levels of natriuretic peptides, and be discharged on lower doses of loop diuretic.

Of note, de novo HF was associated with significantly lower all-cause mortality (9.1 percent vs 25.4 percent; adjusted hazard ratio [aHR], 0.50, 95 percent confidence interval [CI], 0.38–0.66; p<0.001) and significantly greater improvement from baseline in KCCQ-CSS (median, 29.94 vs 23.68; adjusted estimated difference in means, 6.26, 95 percent CI, 3.72–8.81; p<0.001) at 12 months.

Mortality rate was similar following treatment with torsemide vs furosemide in the de novo HF group (7.4 percent per 100 patient-years vs 10.9 percent per 100 patient-years, respectively; aHR, 0.70, 95 percent CI, 0.40–1.14; p=0.15) and the worsening chronic HF group (26.8 percent per 100 patient-years vs 24.0 percent per 100 patient-years, respectively; aHR, 1.08, 95 percent CI, 0.89–1.32; p=0.42; p=0.10).

Likewise, hospitalizations, first all-cause hospitalization, or total hospitalizations at 12 months did not significantly differ following a strategy of torsemide vs furosemide in either the de novo HF or worsening chronic HF group.