Which Diuretic More Effectively Reduces Cardiac Mortality in Patients With HF?

Torsemide can more significantly improve functional status, lower cardiac mortality, and reduce the number of hospitalizations among patients with heart failure (HF) compared with furosemide, according to findings of a new meta-analysis.

To assess the clinical outcomes of the diuretics, the researchers searched the Cochrane, Embase, and MEDLINE databases, as well as the major scientific sessions, for trials and studies that had compared the use of torsemide with the use of furosemide among patients with HF. In all, 9 randomized controlled trials and 10 observational studies from January 1996 through August 2019 were identified that, in total, comprised 19,280 patients.

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All-cause mortality, cardiac mortality, hospitalization due to heart failure, improvement of functional status (defined by New York Heart Association [NYHA] class), and medication adverse effects were the primary outcomes.

During a mean follow-up duration of 15 months, torsemide was associated with a numerically lower risk of hospitalization due to heart failure (10.6%) compared with furosemide (18.4%). 

Patients who had received torsemide were also significantly more likely to improve from NYHA class III or IV to NYHA class I or II (72.5%) than patients who had received furosemide (58.0%). Torsemide was also associated with a lower risk of cardiac mortality (1.5%) than furosemide (4.4%).

According to the study authors, there was no difference in all-cause mortality or medication adverse effects between patients taking torsemide vs furosemide.

—Colleen Murphy

Reference:

Abraham B, Megaly M, Sous M, et al. Meta-analysis comparing torsemide versus furosemide in patients with heart failure. Am J Cardiol. 2020;125(1):92-99. https://doi.org/10.1016/j.amjcard.2019.09.039.