For patients discharged after hospitalization for acute heart failure, does long-term torsemide decrease all-cause mortality more than furosemide?
In this pragmatic trial, there was no difference in all-cause mortality when comparing torsemide with furosemide in patients following hospitalization for acute heart failure. However, interpretation of the study results is limited because of loss to follow-up, crossover of trial participants, and nonadherence to study drugs. Furthermore, new changes in guideline-directed medical therapy for heart failure — specifically, the addition of angiotensin receptor–neprilysin inhibitors and sodium-glucose cotransporter-2 inhibitors — may have affected outcomes as well as diuretic requirements over the course of the trial.
Plan de l'etude:
Randomized controlled trial (nonblinded)
Inpatient (any location) with outpatient follow-up
In this multicenter trial in the United States, investigators randomized patients hospitalized with acute heart failure (either a new diagnosis or worsening of chronic heart failure) to treatment with torsemide (n = 1431) or furosemide (n = 1428) prior to discharge. Medication dosing and frequency of the study drugs were determined by the primary team in the hospital and then managed by outpatient clinicians on discharge. Data on outcomes were obtained via patient/proxy telephone interviews, medical record queries, death records, and the National Death Index. The 2 groups had similar baseline characteristics: median age 65 years, 40% were women, 34% were Black, and 70% had a left ventricular ejection fraction of 40% or less. The median duration of follow-up was 17 months. Approximately 4% of patients in each group were lost to follow-up prior to completion of the trial. There was a 7% crossover rate from torsemide to furosemide, and 4% from furosemide to torsemide, at hospital discharge. Additionally, almost 10% of patients were not taking any loop diuretic at the 6-month follow-up. There was no significant difference detected in the primary outcome of all-cause mortality between the 2 groups (26% in both groups). Further, all-cause mortality and hospitalization over 12 months were similar, with a rate of almost 50% for both groups.
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine