Background: Loop diuretics are recommended by current guidelines for patients with symptomatic heart failure (HF) with NYHA class II-IV. While torsemide's oral bioavailability and half life theoretically render it a more efficacious drug than furosemide, the clinical outcomes of torsemide compared with furosemide in patients with HF remain unclear. Methods: We performed a meta-analysis including all published randomized control trial (RCTs) and observational studies that compared torsemide and furosemide use in chronic HF patients from inception to February 2019. Results: Fifteen studies (eight RCTs and seven observational studies) including 9758 patients were included. Over a weighted mean follow-up duration of 8 §3 months, torsemide was associated with a lower risk of rehospitalization due to HF (8.6% vs. 12.7%, NNT=23) (OR 0.63, 95% CI (0.44, 0.91), p=0.01, I 2 =8%) and cardiac mortality (1.6% vs. 4.4%, NNT=37) (OR 0.37, 95% CI (0.20, 0.66), p<0.001, I 2 =0%); and significantly higher improvement in functional status from NYHA class III/IV to I/II (72.5% vs. 58%, NNT=5) (OR 2.34, 95% CI 1.32, 4.15), p=0.004, I 2 =27%) compared with furosemide. There was no difference in all-cause mortality or medication side effects between both diuretics. In sensitivity analysis including RCTs only, improvement in functional status remained significant between torsemide and furosemide groups; however there was no difference in cardiac mortality between the two groups. With subgroup analysis, there was no difference in rehospitalization due to heart failure when analyzing subgroups of RCTs and observational studies individually. Conclusion: Torsemide use improved functional status and reduced rehospitalization due to HF compared with furosemide in chronic HF patients. Torsemide was also associated with reduced cardiac mortality, but this effect requires further study.
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