Torsemide, furosemide yield similar survival outcomes in heart failure

Treatment with torsemide in survivors of heart failure hospitalization appears to have a similar effect on all-cause mortality over 12 months as furosemide, according to data from the open-label TRANSFORM-HF study.

TRANSFORM-HF enrolled 2,859 patients (median age 65 years, 36.9 percent women, 33.9 percent Black) hospitalized with heart failure (regardless of ejection fraction) and followed up through 30 months for death and 12 months for hospitalizations. Of the patients, 1,431 were treated with loop diuretic strategy of torsemide and 1,428 with furosemide.

Researchers examined the primary outcome of all-cause mortality in a time-to-event analysis. Secondary outcomes included all-cause mortality or all-cause hospitalization and total hospitalizations assessed over 12 months being highest in the hierarchy.

Over a median follow-up of 17.4 months, 113 patients (53 in the torsemide group and 60 in the furosemide group) dropped out of the study. A total of 373 patients (26.1 percent) in the torsemide group and 374 (26.2 percent) in the furosemide group died, with no significant between-group difference (hazard ratio, 1.02, 95 percent confidence interval [CI], 0.89–1.18).

Likewise, all-cause mortality or all-cause hospitalization was similar in the two groups, occurring in 677 patients (47.3 percent) on torsemide and 704 patients (49.3 percent) on furosemide (hazard ratio, 0.92, 95 percent CI, 0.83–1.02). There were 940 and 987 total hospitalizations among 536 and 577 participants in the torsemide and furosemide groups, respectively (rate ratio, 0.94, 95 percent CI, 0.84–1.07).

Results did not differ across subgroups of patients with reduced, mildly reduced, or preserved ejection fraction.

The researchers advised caution when interpreting these findings due to the number of participants lost to follow-up and participant crossover and nonadherence.