In this episode, I’ll discuss torsemide vs furosemide for symptoms and quality of life among patients hospitalized for heart failure.
Whether torsemide improves patient Heart Failure (HF) symptoms and quality of life better than furosemide is a matter of debate among clinicians, and a group of authors recently published an open-label, multi-center, randomized trial in the journal Circulation in an effort to resolve this question.
Almost 3000 patients admitted to a US hospital with heart failure were randomized in a 1:1 ratio to a loop diuretic strategy of torsemide or furosemide. Patients could be enrolled regardless of their ejection fraction (EF) and the local investigator was empowered to determine the dose of diuretic – there was not a standard dosing protocol.
The outcomes were the change in score on the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and the and Patient Health Questionnaire-2.
Baseline scores were similar between groups and the investigators did not find a significant difference between torsemide and furosemide in change from baseline for either scoring system at 12 months. REsults were similar at the shorter follow up periods of 1 and 6 months.
In addition there were no significant differences in the 2 agents when subgroup analysis was done including ejection fraction phenotype, New York Heart Association class at randomization, and loop diuretic agent prior to hospitalization.
The authors concluded:
Among patients discharged after hospitalization for HF, a strategy of torsemide compared with furosemide did not improve symptoms or quality of life over 12 months. The effects of torsemide and furosemide on patient-reported outcomes were similar regardless of ejection fraction, prior loop diuretic use, and baseline health status
It would appear based on this high quality study that there is no difference in clinically meaningful outcomes between furosemide and torsemide and the debate is settled with a tie.
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