Torsemide Comparison With Furosemide for Management of Heart Failure - TRANSFORM-HF

Jun 13, 2023
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
National Heart, Lung, and Blood Institute
Date Presented:
11/05/2022
Date Published:
05/22/2023
Date Updated:
06/13/2023
Original Posted Date:
11/05/2022
References

Contribution To Literature:

Highlighted text has been updated as of June 13, 2023.

The TRANSFORM-HF trial failed to show that torsemide was superior to furosemide in improving survival among patients treated for decompensated heart failure.

Description:

The goal of the trial was to evaluate furosemide compared with torsemide after hospitalization for decompensated heart failure.

Study Design

  • Randomized
  • Parallel
  • Open-label

Patients hospitalized with decompensated heart failure were randomized to furosemide (n = 1,428) vs. torsemide (n = 1,431) after discharge.

  • Total number of enrollees: 2,859
  • Median duration of follow-up: 17.4 months
  • Mean patient age: 64 years
  • Percentage female: 37%

Inclusion criteria:

  • Patients hospitalized with decompensated heart failure regardless of ejection fraction

Principal Findings:

The primary outcome, all-cause mortality, occurred in 26.2% of the furosemide group vs. 26.1% of the torsemide group (p = 0.76).

Secondary outcomes:

  • All-cause mortality or hospitalization: 49.3% of the furosemide group vs. 47.3% of the torsemide group (p = 0.11)

Patient-reported quality of life at 12 months: No significant difference between torsemide vs. furosemide in change from baseline Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) (adjusted mean difference, 0.06; p = 0.96).

Interpretation:

Among patients admitted with decompensated heart failure, post-discharge management with torsemide was not superior to furosemide. All-cause mortality and patient-reported quality of life were similar between treatment groups. Either furosemide or torsemide are acceptable options for diuresis among patients with heart failure.

References:

Greene SJ, Velazquez EJ, Anstrom KJ, et al., on behalf of the TRANSFORM-HF Investigators. Effect of Torsemide vs Furosemide on Symptoms and Quality of Life Among Patients Hospitalized for Heart Failure: The TRANSFORM-HF Randomized Clinical Trial. Circulation 2023;148:124-34.

Mentz RJ, Anstrom KJ, Eisenstein EL, 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;329:214-23.

Editorial: Kittleson MM. TRANSFORM-HF—Can We Close the Loop on Diuretics in Heart Failure? JAMA 2023;329:211-3.

Presented by Dr. Robert J. Mentz at the American Heart Association Scientific Sessions, Chicago, IL, November 5, 2022.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Statins, Acute Heart Failure

Keywords: AHA Annual Scientific Sessions, AHA22, Diuresis, Furosemide, Heart Failure, Patient Discharge, Quality of Life, Stroke Volume, Torsemide


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