Comparative Analysis of Long-Term Outcomes of Torasemide and Furosemide in Heart Failure Patients in Heart Failure Registries of the European Society of Cardiology

Abstract

Purpose. Current clinical recommendations do not emphasise superiority of any of diuretics, but available reports are very encouraging and suggest beneficial effects of torasemide. This study aimed to compare the effect of torasemide and furosemide on long-term outcomes and New York Heart Association (NYHA) class change in patients with chronic heart failure (HF). Methods. Of 2019 patients enrolled in Polish parts of the heart failure registries of the European Society of Cardiology (Pilot and Long-Term), 1440 patients treated with a loop diuretic were included in the analysis. The main analysis was performed on matched cohorts of HF patients treated with furosemide and torasemide using propensity score matching. Results. Torasemide was associated with a similar primary endpoint (all-cause death; 9.8% vs. 14.1%; p = 0.13) occurrence and 23.8% risk reduction of the secondary endpoint (a composite of all-cause death or hospitalisation for worsening HF; 26.4% vs. 34.7%; p = 0.04). Treatment with both torasemide and furosemide was associated with the significantly most frequent occurrence of the primary (23.8%) and secondary (59.2%) endpoints. In the matched cohort after 12 months, NYHA class was higher in the furosemide group (p = 0.04), while furosemide use was associated with a higher risk (20.0% vs. 12.9%; p = 0.03) of worsening ≥ 1 NYHA class. Torasemide use impacted positively upon the primary endpoint occurrence, especially in younger patients (aged < 65 years) and with dilated cardiomyopathy. Conclusions. Our findings contribute to the body of research on the optimal diuretic choice. Torasemide may have advantageous influence on NYHA class and long-term outcomes of HF patients, especially younger patients or those with dilated cardiomyopathy, but it needs further investigations in prospective randomised trials.

Comparative effectiveness of torasemide versus furosemide in symptomatic therapy in heart failure patients: Preliminary results from the randomized TORNADO trial

“…Recent analysis from the Heart Failure Registries of the European Society of Cardiology revealed that use of torasemide was associated with significantly lower NYHA class comparing to furosemide treatment (p = = 0.04). During follow-up torasemide use was associated with a lower risk (12.9% vs. 20.0%; p = 0.03) of worsening ≥ 1 NYHA functional class (12.9% vs. 20.0%; p = 0.03) [18]. TORIC (TORasemide In Congestive HF) study that revealed significantly higher efficiency of torasemide than furosemide and other diuretics in functional improving of at least 1 grade in NYHA class (45.8% vs. 37.2%; p = 0.00017) [19].…”

“…Analysis of the Polish parts of Heart Failure Registries of the European Society of Cardiology, Pilot and Long-Term, revealed that use of torasemide was associated with a significant 24% risk reduction of the composite endpoint of allcause death and hospitalization for worsening HF (26.4% vs. 34.7%; p = 0.04). These benefits may be due to the additional advantages of torasemide such as anti-aldosterone effect [18].…”

Effects of Sodium–Glucose Co-transporter 2 Inhibition with Empaglifozin on Renal Structure and Function in Non-diabetic Rats with Left Ventricular Dysfunction After Myocardial Infarction

“…HF patients are often treated with diuretics to prevent or treat congestion, but little is known about their effect on prognosis [16,32]. In high doses, diuretics activate the renin-angiotensin-aldosterone system (RAAS) and may [33,34]. Furthermore, diuretics can cause plasma volume contraction, worsen renal function and can cause various electrolyte disturbances including hypokalemia, hypomagnesemia, hypocalcemia, hyponatremia and hyperuricemia [35][36][37].…”

Efficacy of oral torasemide in dogs with degenerative mitral valve disease and new onset congestive heart failure: The CARPODIEM study

“…The comparative effect of torasemide vs furosemide on survival time in humans is a subject of interest, with 1 study 10 in favor of torasemide and others 8,9,22,23 reporting a neutral effect. The effects of torasemide on other important patient‐centered endpoints such as quality of life, heart failure class, and hospitalization in human patients with CHF generally favor torasemide 8,9,24‐27 . One problem common to these studies is that patients with more severe disease were more likely to be prescribed torasemide 25 .…”