Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure
Author:
Mentz Robert J.12, Anstrom Kevin J.3, Eisenstein Eric L.1, Sapp Shelly1, Greene Stephen J.12, Morgan Shelby1, Testani Jeffrey M.4, Harrington Amanda H.1, Sachdev Vandana5, Ketema Fassil5, Kim Dong-Yun5, Desvigne-Nickens Patrice5, Pitt Bertram6, Velazquez Eric J.4, Adams Kirkwood F.7, Bhatt Kunal7, DeWald Tracy7, Axsom Kelly M.7, Murthy Sandhya7, Rich Jonathan D.7, Testani Jeffrey7, Smith Bryan A.7, Vader Justin M.7, McCulloch Michael D.7, Skopicki Hal A.7, Psotka Mitchell A.7, Heroux Alain L.7, Lala-Trindade Anuradha7, Stevens Gerin R.7, Tang WH Wilson7, Lev Yair A.7, William Preethi7, Eberly Arthur L.7, Gottleib Stephen S.7, Haught W. Herbert7, Grafton Gillian F.7, Larned Joshua M.7, Tejwani Lokesh K.7, Mody Freny V.7, Krim Selim R.7, Robinson Monique T.7, Fang James C.7, Adler Alexander A.7, Bell Adrian C.7, Banerjee Dipanjan7, Ruiz Duque Ernesto A.7, Mizyed Ahmad M.7, Rommel John J.7, Arhinful Justice S.7, Goyal Parag7, Hall Michael E.7, Hummel Scott L.7, Shetty Sanjay7, Haas Donald C.7, Vilaro Juan R.7, Alexy Tamas7, Herre John M.7, Clark John M.7, Ambrosy Andrew P.7, Gaglianello Nunzio A.7, Ramasubbu Kumudha7, Meadows Judith L.7, Tabtabai Sara R.7, Sherwood Melody7, Hasni Syed7, D'Urso Michael7, Muneer Basharat7, Dunlap Stephanie H.7, Davis William7, Friedman Dennis7, Guglin Maya7, Ferguson Andrew D.7, Abbate Antonio7, Smart Frank7,
Affiliation:
1. Duke Clinical Research Institute, Durham, North Carolina 2. Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina 3. Gillings School of Global Public Health, University of North Carolina at Chapel Hill 4. Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut 5. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland 6. Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor 7. for the TRANSFORM-HF Investigators
Abstract
ImportanceAlthough furosemide is the most commonly used loop diuretic in patients with heart failure, some studies suggest a potential benefit for torsemide.ObjectiveTo determine whether torsemide results in decreased mortality compared with furosemide among patients hospitalized for heart failure.Design, Setting, and ParticipantsTRANSFORM-HF was an open-label, pragmatic randomized trial that recruited 2859 participants hospitalized with heart failure (regardless of ejection fraction) at 60 hospitals in the United States. Recruitment occurred from June 2018 through March 2022, with follow-up through 30 months for death and 12 months for hospitalizations. The final date for follow-up data collection was July 2022.InterventionsLoop diuretic strategy of torsemide (n = 1431) or furosemide (n = 1428) with investigator-selected dosage.Main Outcomes and MeasuresThe primary outcome was all-cause mortality in a time-to-event analysis. There were 5 secondary outcomes with all-cause mortality or all-cause hospitalization and total hospitalizations assessed over 12 months being highest in the hierarchy. The prespecified primary hypothesis was that torsemide would reduce all-cause mortality by 20% compared with furosemide.ResultsTRANSFORM-HF randomized 2859 participants with a median age of 65 years (IQR, 56-75), 36.9% were women, and 33.9% were Black. Over a median follow-up of 17.4 months, a total of 113 patients (53 [3.7%] in the torsemide group and 60 [4.2%] in the furosemide group) withdrew consent from the trial prior to completion. Death occurred in 373 of 1431 patients (26.1%) in the torsemide group and 374 of 1428 patients (26.2%) in the furosemide group (hazard ratio, 1.02 [95% CI, 0.89-1.18]). Over 12 months following randomization, all-cause mortality or all-cause hospitalization occurred in 677 patients (47.3%) in the torsemide group and 704 patients (49.3%) in the furosemide group (hazard ratio, 0.92 [95% CI, 0.83-1.02]). There were 940 total hospitalizations among 536 participants in the torsemide group and 987 total hospitalizations among 577 participants in the furosemide group (rate ratio, 0.94 [95% CI, 0.84-1.07]). Results were similar across prespecified subgroups, including among patients with reduced, mildly reduced, or preserved ejection fraction.Conclusions and RelevanceAmong patients discharged after hospitalization for heart failure, torsemide compared with furosemide did not result in a significant difference in all-cause mortality over 12 months. However, interpretation of these findings is limited by loss to follow-up and participant crossover and nonadherence.Trial RegistrationClinicalTrials.gov Identifier: NCT03296813
Publisher
American Medical Association (AMA)
Cited by
53 articles.
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