Torsemide and Furosemide Have Similar Mortality Rates in Patients With Heart Failure

A study published in JAMA did not find significant differences in the rate of all-cause mortality at 12 months among patients who received torsemide or furosemide following heart failure (HF) hospital discharge.

The TRANSFORM-HF (Torsemide Comparison With Furosemide for Management of Heart Failure; ClinicalTrials.gov Identifier: NCT03296813) trial was an open-label, pragmatic randomized trial conducted at 60 hospitals in the United States between 2018 and 2020. Patients (N=2859) hospitalized for HF were randomly assigned in a 1:1 ratio to receive torsemide (n=1431) or furosemide (n=1428) dosed at their physicians’ discretion for 12 months. Patients were contacted by telephone at 30 days and 6 and 12 months. The primary outcome of this study was all-cause mortality at 12 months.

The torsemide and furosemide cohorts comprised patients with median ages of 65.0 (IQR, 55.0-74.0) and 65.5 (IQR, 56.0-75.0) years, 65.2% and 61.0% were men, 58.1% and 58.6% were White, 29.9% and 28.7% had newly diagnosed HF, and 70.1% and 69.3% had left ventricular ejection fraction (LVEF) of less than 40%, respectively. Overall, 81.5% of patients used b-blockers, 67.5% used angiotensin-converting enzyme/angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors, and 44.3% used mineralocorticoid receptor antagonists at baseline.

Using a 2:1 conversion of furosemide to torsemide, the average dose at discharge was similar for furosemide and torsemide (mean, 79.1 vs 79.5 mg), respectively. At discharge, 90.4% of patients were receiving their assigned treatment. Crossover rates of 7.0% for torsemide and 3.8% for furosemide were observed. At 30 days 7.0% of patients were not taking any loop diuretics and the rate increased to 9.5% at 6 months.

During a median follow-up of 17.4 months, 26.1% of the torsemide and 26.2% of the furosemide cohorts died (hazard ratio [HR], 1.02; 95% CI, 0.89-1.18; P =.76). Risk for all-cause mortality or all-cause hospitalization at 12 months (HR, 0.92; 95% CI, 0.83-1.02), total hospitalizations at 12 months (rate ratio [RR], 0.94; 95% CI, 0.84-1.07), and all-cause mortality or all-cause hospitalization at 30 days (HR, 0.94; 95% CI, 0.75-1.18) were similar between cohorts.

In the subgroup analyses, no significant interactions were observed, and no treatment was preferred over the other for the outcome of mortality at 12 months.

The major limitations of this study are that the sample size is half of what was originally planned, and the rate of patient withdrawal is higher in this study than previous HF trials.

“Among patients discharged after hospitalization for HF, torsemide compared with furosemide did not result in a significant difference in all-cause mortality over 12 months,” the study authors wrote. “However, interpretation of these findings is limited by loss to follow-up and participant crossover and nonadherence.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.