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 (Lasix) is the most widely used diuretic in heart failure patients. Torsemide (Demadex) has a better pharmacokinetic and pharmacodynamic profile than does furosemide, with greater bioavailability, a longer half-life, and higher potency. In addition, there is a suggestion that torsemide has a vasodilatory effect and a possible antialdosterone effect that may contribute to its efficacy. However, it is not known if that better profile leads to differences or improvements in primary treatment goals.

Dr. Margaret Tsien

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. Am J Cardiol. 2020 Jan 1;125: 92-9.

Dr. Tsien is assistant professor in the division of hospital medicine, Loyola University Medical Center, Maywood, Ill.