Patients with heart failure who received either furosemide or torsemide after hospital discharge had similar death and hospitalization rates, according to recent research presented at the American Heart Association’s Scientific Sessions 2022.

The open-label, randomized, 2-arm, multicenter phase 3 TRANSFORM-HF trial ( Identifier: NCT03296813) enrolled nearly 3000 hospitalized patients with heart failure across more than 60 hospitals. The median age was 65 years, 37% were women, and 34% were Black adults. 

Prior to hospital discharge, patients were randomly assigned 1:1 to receive either torsemide or furosemide. The primary endpoint was all-cause mortality over a follow-up period of 12 months, as measured by follow-up phone calls at 30 days, 6 months, and 12 months after discharge.

After a median of 17.4 months, death rates were reported to be 26.1% in the torsemide arm and 26.2% in the furosemide arm. At 12 months, all-cause mortality and hospitalization rates were found to be comparable between the groups (47.3% for torsemide and 49.3% for furosemide). Similar outcomes were observed across all prespecified subgroups, including ejection fraction.

“We were disappointed at first because we hoped that there would be a significant clinical difference between these 2 medicines based on prior studies and clinical experience,” said the study’s lead author Robert J. Mentz, MD, FAHA, an associate professor of medicine, an associate professor of population health sciences at Duke University School of Medicine, and a chief of the heart failure section at Duke Clinical Research Institute in Durham, North Carolina. “While we did not see better outcomes with torsemide, these results help inform our ability to take better care of people living with heart failure.”

The researchers did note several study limitations, including patients discontinuing treatment or switching between diuretics during follow-up. Additionally, the dosages were chosen by the clinicians, which may have influenced the outcomes.


TRANSFORM-HF trial found no difference in effectiveness between 2 common loop diuretics. News release. American Heart Association. Accessed November 7, 2022.