Home > Cardiology > AHA 2022 > What Is New in Heart Failure > Torsemide not superior to furosemide after hospitalisation for heart failure

Torsemide not superior to furosemide after hospitalisation for heart failure

Presented by
Prof. Robert Mentz, Duke University Hospital, NC, USA
AHA 2022
Treatment with loop diuretic torsemide did not show a survival benefit for patients with heart failure (HF) post-discharge compared with furosemide in the phase 3 TRANSFORM-HF trial. The results also showed no difference in total hospitalisations at 12 months.

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]. “We 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,” 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 ≤40% and, among those, more than 80% received treatment with β-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 0.89–1.18; 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 0.83–1.02; 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.

  1. Mentz RJ. Comparative effectiveness of torsemide versus furosemide in heart failure: Primary results of the TRANSFORM-HF trial. 01, AHA Scientific Sessions 2022, 05–07 November, Chicago, USA.


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