Patients treated for heart failure (HF) with the loop diuretic torsemide had similar rates of death and hospitalization compared with those treated with furosemide, a more commonly prescribed diuretic, according to results of the TRANSFORM-HF trial presented Nov. 5 as part of AHA 2022 in Chicago.

The pragmatic, open label study randomized 2,859 patients at more than 60 U.S. hospitals to either torsemide or furosemide. Of the participants, more than one-third were women, one-third were Black, and the median age was 65 years. Researchers also noted a broad range in the severity of HF ranging from recent diagnosis to worsening stages. Follow-up via phone was conducted at 30 days, six months and 12 months after hospital discharge.

After a median of 17.4 months, results showed nearly identical mortality rates in both the torsemide (26.1%) and the furosemide (26.2%) groups. At 12 months, all-cause death and hospitalization rates were also similar in the torsemide (47.3%) and furosemide (49%.3) groups. Researchers noted the primary outcome demonstrating furosemide equivalence to torsemide was the same across all pre-specified subgroups including ejection fraction.

"We hoped to find that torsemide would reduce patient deaths and rehospitalizations," said lead investigator Robert J. Mentz, MD, FACC. "We were disappointed at first because we hoped that there would be a significant clinical difference between these two medicines based on prior studies and clinical experience. While we did not see better outcomes with torsemide, these results help inform our ability to take better care of people living with HF."

According to Mentz and colleagues, future work should now focus on appropriate dosing of diuretics and opportunities to address non-adherence to improve patient outcomes. They also noted that the trial's pragmatic design and execution could be a model to inform future studies looking at real-world comparative effectiveness. Among the benefits, Mentz said "broad eligibility criteria and streamlined study protocol embedded within routine care supported the inclusion of diverse participants," while pragmatic elements of the trial "lowered traditional barriers for patient and site participation."

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

Keywords: AHA Annual Scientific Sessions, AHA22, Torsemide, Furosemide, Heart Failure, Sodium Potassium Chloride Symporter Inhibitors

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