The, randomised, phase 3 TRANSFORM-HF trial (NCT03296813) compared long-term clinical outcomes of treatment with furosemide versus torsemide after hospitalisation in patients with HF [1]. âWe focused on the recruitment of hospitalised patients with HF, wielding eligibility criteria that included patients regardless of ejection fraction, as long as there was a long-term plan for a loop diuretic,â Prof. Robert Mentz (Duke University Hospital, NC, USA) explained. The open-label dosing regimens were left at the discretion of the treating clinician. Follow-up was performed without in-person study visits after 30 days, 6 months, and 12 months. The primary endpoint was all-cause mortality.
TRANSFORM-HF randomised 2,859 patients (out of a planned 6,000) between 2019 and 2022 in a 1:1 fashion. Baseline characteristics showed well-balanced groups with a mean age of 65 years, 37% women, and 34% self-identified as Black. Around 64% had a reduced ejection fraction of â€40% and, among those, more than 80% received treatment with ÎČ-blockers and more than two-thirds received medications affecting the renin-angiotensin-system. Upon trial entry, 67% of the participants were already treated with a loop diuretic, primarily furosemide. At baseline, the total daily dose was equivalent to 66 mg of furosemide in both groups. After discharge, the furosemide equivalent dose in both arms was about 80 mg.
All-cause mortality over 12 months was high in both treatment arms with 374 (26.2%) deaths on furosemide and 373 (26.1%) on torsemide. This translated into 17.0 events/100 patient-years (PY) in both arms and a corresponding hazard ratio of 1.02 (95% CI 0.89â1.18; P=0.77). In terms of the composite secondary endpoint of all-cause mortality or hospitalisation over 12 months, the findings were very similar: 704 events (49.3%) in the furosemide group versus 677 events (47.3%) in the torsemide arm (107.6 events/100 PY vs 99.2 events/100 PY, respectively), leading to a hazard ratio of 0.92 (95% CI 0.83â1.02; P=0.11).
At 12 months, the total hospitalisation rate also did not significantly differ between the study groups. At discharge after the index event, 5.4% of participants had crossed over from furosemide to torsemide or vice versa, while 2.8% of participants did not receive a loop diuretic at all. After 30 days of follow-up, these percentages rose to 6.7% of participants crossing over and 7.0% of participants not receiving a loop diuretic.
The trial overall did not show superiority of torsemide. Prof. Mentz stressed that insights from the pragmatic trial design and execution could inform future studies aiming to assess real-world effectiveness in diverse populations.
- Mentz RJ. Comparative effectiveness of torsemide versus furosemide in heart failure: Primary results of the TRANSFORM-HF trial. 01, AHA Scientific Sessions 2022, 05â07 November, Chicago, USA.
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Table of Contents: AHA 2022
Featured articles
What Is New in Heart Failure
Torsemide not superior to furosemide after hospitalisation for heart failure
IRONMAN failed primary endpoint but shows potential long-term benefits of iron repletion in HF patients
Up-titration of HF therapies following HF discharge saves lives
Hypertension: Novel Developments
The endothelin system: a new target for resistant high blood pressure
Can renal denervation lower BP on top of antihypertensive drugs?
Quadruple, ultra-low-dose treatment did not meet primary endpoint in hypertension
Mindfulness programme contributes to office blood pressure lowering
Interventional Cardiology in 2022
Grafting with the radial vein: an underrated option in CABG surgery?
Extracorporeal membrane oxygenation not superior to conservative therapy in cardiogenic shock
Surgery with adequate saphenous vein partly better than endovascular treatment in CLTI
Arrhythmia â State of the Art
First-line ablation limits progression to persistent AF
Doubling the dose of self-administered etripamil terminates PSVT
Novel Developments in Primary and Secondary Prevention
Grafting with the radial vein: an underrated option in CABG surgery?
Digitally delivered cognitive behavioural therapy successful in type 2 diabetes
Empagliflozin reduces risk of kidney disease progression and CV events in patients with CKD
RESPECT-EPA misses primary endpoint but hints towards improvements in CV outcomes by EPA
Pemafibrate fails to reduce cardiovascular events in diabetes but may benefit the liver
Dietary supplements not effective in lowering LDL-C, use of low-dose statins encouraged
No sex differences in lipid-lowering effect and treatment benefit of PCSK9 inhibitors
COVID-19 and the Heart
‘Noâ to routine use of rivaroxaban in outpatients with COVID-19
COVID-19 pandemic: Older adults and those affected by the delta variant experienced increased cardiovascular morbidity and mortality
COVID-19 mRNA vaccination does not amplify risk of cardiovascular hospitalisation
Best of the Posters
Higher LDL-cholesterol levels linked to higher CVD mortality risk in the elderly
AF: Moderate alcohol intake possibly associated with a reduced mortality risk
Periodontitis: An independent risk factor for AF
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