Background: Treatment goals of heart failure include improvement in quality of life, prevention of hospitalization, and decreases in mortality. Loop diuretics can improve these goals. Furosemide (
Study design: Systematic review and meta-analysis.
Setting: 19 published randomized, controlled trials (RCTs) or observational studies in the English language.
Synopsis: 19 RCTs and observational studies comparing furosemide and torsemide were analyzed to identify differences in New York Heart Association functional classification, side effects, hospitalizations for heart failure, cardiac mortality, and all-cause mortality. More than 19,000 patients were included with a mean follow-up of 15 months. Torsemide was associated with a significant improvement in functional status with a number needed to treat of five. In addition, there were lower numbers of hospitalizations from heart failure and a lower risk of cardiac death in the torsemide arm though these differences disappeared when RCTs were analyzed alone. There were no differences in all-cause mortality or medication side effects between furosemide and torsemide.
Bottom line: The use of torsemide is associated with significant improvement in functional status. It is also – though less significantly – associated with lower hospitalization rates for heart failure and lower cardiac mortality.
Citation: Abraham B et al. Meta-analysis comparing torsemide versus furosemide in patients with heart failure..
Dr. Tsien is assistant professor in the division of hospital medicine, Loyola University Medical Center, Maywood, Ill.