Similar effectiveness of two loop diuretics on mortality in patients with HF

AHA 2022 The TRANSFORM-HF trial investigated whether treatment with torsemide improves long term clinical outcomes compared with furosemide in patients hospitalized with HF.

Presented at the AHA Scientific Sessions 2022 by: Robert J. Mentz, MD - Durham, NC, USA

Introduction and methods

The most commonly used loop diuretic to manage congestion in patients with heart failure is furosemide. Another loop diuretic, torsemide, is known to have better bioavailability and longer duration of action compared with furosemide. In addition, torsemide has anti-aldosterone and anti-fibrotic myocardial effects. This study investigated whether treatment with torsemide improves long term clinical outcomes compared with furosemide in patients hospitalized with HF.

TRANSFORM-HF was a pragmatic open-label trial which was conducted at 60 sites in the US. A total of 2859 hospitalized patients with HF were randomized 1:1 to torsemide or furosemide. The primary endpoint was all-cause mortality. Secondary endpoints were all-cause mortality or all-cause hospitalization, and total hospitalizations. Median follow-up was 17.4 months (IQR 8.0 – 29.0). Secondary endpoints were evaluated at 12 months.

Main results

• There was no difference in effectiveness between furosemide and torsemide on all-cause mortality (HR 1.02, 95% CI 0.89-1.18, P=0.77).
• There were also no differences between treatment groups for the secondary endpoints of all-cause mortality or hospitalization (HR 0.92, 95% CI 0.83-1.02, P=0.11), and total hospitalizations (RR 0.94, 95% CI 0.84-1.07).

Conclusion

This open-label pragmatic trial showed similar effectiveness between furosemide and torsemide on all-cause mortality in hospitalized patients with HF.

-Our reporting is based on the information provided at the AHA Scientific Sessions-