Comparative effectiveness of loop diuretics on mortality in the treatment of patients with chronic heart failure – A multicenter propensity score matched analysis

Täger, Tobias; Fröhlich, Hanna; Grundtvig, Morten; Seiz, Mirjam; Schellberg, Dieter; Goode, Kevin; Kazmi, Syed; Hole, Torstein; Katus, Hugo A.; Atar, Dan; Cleland, John G.F.; Agewall, Stefan; Clark, Andrew L.; Frankenstein, Lutz

doi:10.1016/j.ijcard.2019.01.109

Cited by 10 publications

(3 citation statements)

References 47 publications

(68 reference statements)

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“…As previously stated, the specific torasemide and furosemide doses employed in our study were based on the production of equivalent degrees of diuresis 3,16,17 and were in general agreement with a previous clinical trial 14 . 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 .…”

Section: Discussionsupporting

confidence: 79%

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

Besche¹,

Blondel²,

Guillot³

et al. 2020

Veterinary Internal Medicne

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Background: Torasemide is a potent loop diuretic with potential to treat congestive heart failure (CHF) in dogs. Objective: Evaluate the efficacy and safety of torasemide compared to furosemide in dogs with first occurrence of CHF caused by degenerative mitral valve disease (DMVD). Animals: Three hundred and nineteen dogs with new onset CHF attributable to DMVD. Methods: Double-blinded randomized noninferiority study of PO torasemide vs furosemide in addition to standard CHF treatment. The primary efficacy criterion was decreased pulmonary edema and cough and no worsening of dyspnea or exercise tolerance at day 14. Secondary endpoints included clinical response at day 84 and time to death, euthanasia, or premature study withdrawal for cardiac reasons. Results: Torasemide q24h (n = 161) was noninferior to furosemide q12h (n = 158); percentage of dogs meeting primary efficacy criterion at day 14 was similar between groups (torasemide, 74.4% [95% confidence interval (CI), 66.8%-81.0%] vs. furosemide, 73.5% [95% CI, 65.7%-80.4%]; risk ratio [RR], 1.01; 95% CI, 0.89-1.15; P = .87). Efficacy at day 84 showed similar results (RR, 1.05; 95% CI, 0.88-1.25; P = .6). Dogs receiving torasemide had a longer time to endpoint and were less than half as likely to experience death, euthanasia, or premature study withdrawal (hazard ratio, 0.36; 95% CI, 0.19-0.65; P = .001) than dogs receiving furosemide at any time during the study. Conclusion and Clinical importance: Torasemide was noninferior to furosemide as first line PO treatment for new onset CHF caused by DMVD. Torasemide significantly decreased risk of cardiac-related death or premature study withdrawal for cardiac reasons compared to furosemide.

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Section: Discussionsupporting

confidence: 79%

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

Besche¹,

Blondel²,

Guillot³

et al. 2020

Veterinary Internal Medicne

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“…Multicentre PSM analysis of different LDs use (e.g. bumetanide, furosemide, and torasemide) on mortality in CHF patients showed that mortality was not affected by the choice of individual LDs 40 as well as the mode of administration (oral vs. subcutaneous injection) 41 . However, LDs treatment decreased the short‐term (within 1 year) HF readmission by 70% compared with TDs treatment ( Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of diuretics in rheumatic heart disease with compensated chronic heart failure: a retrospective study

et al. 2020

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Aims The purpose of this retrospective propensity score-matched study was to evaluate the superiority of different application approaches [continuous diuretics use (CDU) vs. intermittent diuretics use (IDU)] and types [loop diuretics (LDs) vs. thiazide diuretics (TDs)] of diuretics on long-term outcomes for rheumatic heart disease (RHD) patients with compensated chronic heart failure (CHF). Methods and results A total of 494 RHD patients with compensated CHF were analysed after propensity score matching. Cox proportional hazards regression model was used to investigate the associations of different diuretic application approaches and types with all-cause mortality, cardiovascular death (CVD), and cerebrovascular death. Binary logistic regression analyses were used to evaluate the associations of different diuretic application approaches and types with 1-, 3-, and 5-year heart failure (HF) re-hospitalization as well as new-onset atrial fibrillation (AF). In the comparison between IDU and CDU strategies for RHD patients with compensated CHF, CDU was associated with increased risks of all-cause mortality [adjusted hazard ratio (HR) = 2.47, 95% confidence interval (CI): 1.54-3.97, P < 0.001] and CVD (adjusted HR = 3.67, 95% CI: 1.95-6.89, P < 0.001) except cerebrovascular death (adjusted HR = 1.07, 95% CI: 0.34-3.41, P = 0.905). CDU was also associated with increased risks of 3-year [adjusted odds ratio (OR) = 1.80, 95% CI: 1.09-2.96, P = 0.022] and 5-year (adjusted OR = 2.02, 95% CI: 1.18-3.45, P = 0.010) HF re-hospitalization risk and new-onset AF (adjusted OR = 2.34, 95% CI: 1.31-4.20, P = 0.004) except 1-year HF re-hospitalization risk (adjusted OR = 1.54, 95% CI: 0.88-2.70, P = 0.130). In the comparison between TDs and LDs among study participants receiving IDU strategy, LDs were only associated with decreased 1-year HF re-hospitalization risk (adjusted OR = 0.30, 95% CI: 0.12-0.77, P = 0.012) rather than all-cause mortality, CVD, cerebrovascular death, 3and 5-year HF rehospitalization, and new-onset AF (all adjusted P > 0.05). In the comparison between TDs and LDs among study participants receiving CDU strategy, LDs were not associated with cerebrovascular death and 1-year HF re-hospitalization (both adjusted P > 0.05) but with increased risks of all-cause mortality (adjusted

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“…No data was collected on symptoms, diuresis, or congestion at different time points, so we do not know if the prognosis was poor due to inadequate diuresis, or residual congestion at the point of discharge. Regardless, given the high event rate and neutral findings, it is probable that the type of loop diuretic used is not important [ 66 ].…”

Section: Loop Diureticsmentioning

confidence: 99%

Diuretic Treatment in Patients with Heart Failure: Current Evidence and Future Directions – Part I: Loop Diuretics

Cuthbert,

Clark

2024

Curr Heart Fail Rep

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Purpose of Review Fluid retention or congestion is a major cause of symptoms, poor quality of life, and adverse outcome in patients with heart failure (HF). Despite advances in disease-modifying therapy, the mainstay of treatment for congestion—loop diuretics—has remained largely unchanged for 50 years. In these two articles (part I: loop diuretics and part II: combination therapy), we will review the history of diuretic treatment and the current trial evidence for different diuretic strategies and explore potential future directions of research. Recent Findings We will assess recent trials including DOSE, TRANSFORM, ADVOR, CLOROTIC, OSPREY-AHF, and PUSH-AHF amongst others, and assess how these may influence current practice and future research. Summary There are few data on which to base diuretic therapy in clinical practice. The most robust evidence is for high dose loop diuretic treatment over low-dose treatment for patients admitted to hospital with HF, yet this is not reflected in guidelines. There is an urgent need for more and better research on different diuretic strategies in patients with HF.

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Comparative effectiveness of loop diuretics on mortality in the treatment of patients with chronic heart failure – A multicenter propensity score matched analysis

Abstract: Comparative effectiveness of loop diuretics on mortality in the treatment of patients with chronic heart failure-a multicenter propensity score matched analysis.

Cited by 10 publications

References 47 publications

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

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

Outcomes of diuretics in rheumatic heart disease with compensated chronic heart failure: a retrospective study

Diuretic Treatment in Patients with Heart Failure: Current Evidence and Future Directions – Part I: Loop Diuretics

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