study found that the use of torsemide and furosemide did not result in significant differences in clinical outcomes in patients hospitalized with heart failure (HF), regardless of baseline left ventricular ejection fraction (LVEF) status. Circulation: heart failure.

This result comes from a prespecified analysis of the TRANSFORM-HF (Comparison of Torsemide and Furosemide for Heart Failure Management; ClinicalTrials.gov Identifier: NCT03296813) trial. This study was an open-label, prospective, randomized, event-driven study that enrolled hospitalized patients. Heart failure in his 60 hospitals in the United States. Participants were enrolled regardless of LVEF and HF history.

Patients were randomly assigned to furosemide or torsemide in a 1:1 ratio without stratification. LVEF was divided into HF with reduced ejection fraction (HFrEF; LVEF, ≤40%), HF with mildly reduced ejection fraction (HFmrEF; LVEF, 41%-49%), and HF with preserved ejection fraction ( HFpEF; LVEF, ≥50). %).

Results from secondary analyzes included all-cause mortality at 12 months, all-cause mortality or hospitalization at 12 months, all-cause mortality or hospitalization at 30 days, all-cause hospitalization at 12 months, and This was the total number of hospitalizations at 12 months.

TRANSFORM-HF enrolled 2,859 patients, of whom 2,635 (92.1%, 1,334 of 1,431 in the torsemide group and 1,301 of 1,428 in the furosemide group) had available LVEF data. were included in this analysis. The average age of participants was 64 years, 36% were female, and 34% were black. Patients with HFpEF were more likely to be female and older, and had elevated blood urea nitrogen concentrations and lower estimated glomerular filtration rates compared to other groups.

The cumulative incidence of all-cause mortality at 12 months was 17.9, 17.2, and 17.4 deaths per 100 patient-years in the HFrEF, HFmrEF, and HFpEF groups, respectively (adjusted hazard ratio). [aHR]0.91 [95% CI, 0.59-1.39] 0.91 for HFmrEF vs. HFrEF and aHR [95% CI, 0.70-1.17] For HFpEF and HFrEF. P_{Alternating current} =.73).

The 12-month all-cause hospitalization rates were 47.4, 51.9, and 52.1 per 100 patient-years (aHR, 1.12 [95% CI, 0.86-1.46] HFmrEF vs. HFrEF and aHR, 1.08 [95% CI, 0.92-1.27] For HFpEF and HFrEF, P_{Alternating current} =.53).

In unadjusted and adjusted analyses, improvements in Kansas City Cardiomyopathy Questionnaire (KCCQ) Clinical Summary scores between baseline and 12 months, based on estimated differences in means, were significantly greater for the HFmrEF subgroup compared to the HFrEF subgroup. It was not significant in the HFpEF subgroup.

Regarding treatment efficacy, no significant differences were found between torsemide and furosemide on any clinical endpoint, and results were consistently neutral regardless of LVEF subgroup (all P_{Alternating current} >.20).

Limitations include the secondary analysis of a neutral trial, and the sample size was approximately half of what was originally planned. Furthermore, the assessment of his LVEF by echocardiography varied, and TRANSFORM-HF was an open-label study.

“Given similar therapeutic effects across the LVEF spectrum, factors such as patient out-of-pocket costs, availability, and tolerability become particularly important when deciding on routine use of torsemide and furosemide. “possibly,” the researchers wrote.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original bibliography for a complete list of author disclosures.