Clinical question: Is there a mortality difference in patients discharged on torsemide versus furosemide after heart failure hospitalization?
Background: Torsemide has been thought to be superior to furosemide in patients with congestive heart failure (CHF), but no high-quality, randomized, controlled, trial data were available comparing different loop diuretics in patients with CHF and looking at all-cause mortality until the TRANSFORM-HF trial.
Study design: Open-label, pragmatic, randomized, controlled trial
Setting: 60 U.S. hospitals
Synopsis: 2,859 patients with a median age of 65 years randomized to torsemide (1,431) and furosemide (1,428). Patients were followed over 12 months looking at all-cause mortality or all-cause hospitalization. Death occurred in 373 (26.1%) of the torsemide group and 374 (26.2%) of the furosemide group (HR, 1.02; 95% CI, 0.89 to 1.18). All-cause mortality, or all-cause hospitalization (over 12 months) occurred in 677 patients (47.3%) in the torsemide group and 704 patients (49.1%) in the furosemide group (HR, 0.94; 95% CI, 0.83 to 1.02). There were no significant differences in secondary outcomes of total hospitalizations over 12 months, or all-cause mortality or all-cause hospitalization over 30 days. There were similar results across prespecified subgroups (including patients with reduced, mildly reduced, or preserved ejection fraction). Important limitations of this trial include that the sample size was only half of the initial target, crossover occurred during follow-up, and dosing was left to the clinician’s discretion.
Bottom line: For patients discharged after heart failure hospitalization, torsemide in comparison with furosemide did not result in a significant difference in all-cause mortality over 12 months.
Citation: Mentz RJ, 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):214-23.
Dr. Barot is the medical director of the virtual hospital at Atrium Health Wake Forest Baptist, and an assistant professor of hospital medicine at Wake Forest School of Medicine, both in Winston-Salem, N.C.