TRANSFORM-HF trial shows no difference in survival outcomes for heart failure treatment with torsemide or furosemide

The new study supported by the National Institutes of Health and published in the Journal of the American Medical Association compared the outcomes for heart failure patients in the US and showed that both torsemide and furosemide achieved the same survival rates.

Heart failure is most common in people aged 65 years or older, affecting more than 6 million individuals in the US. The American Heart Association predicts this will rise to in excess of 8 million people in the US alone by 2030. Furosemide and torsemide are two widely used diuretics used to treat adults with heart failure. Some studies have indicated that torsemide may be more beneficial; therefore, researchers are keen to understand which treatment works best and for whom.

TRANSFORM-HF (Torsemide Comparison with Furosemide for Management of Heart Failure) was an open-label, pragmatic, randomized trial supported by the National Institutes of Health. The study included 2859 participants, with a median age of 65 years and high proportion of women (almost 37%) and Black Americans (almost 34%). All participants were hospitalized with heart failure and treated at 60 hospitals in the US. Participants were split into two groups, with half receiving torsemide (1431 people) and the other half furosemide (1428 people), and their survival outcomes monitored for an average of 17 months.

After a median follow-up of 17.4 months, there was no difference in all-cause mortality between the two groups, with death occurring in 26.1% of those treated with torsemide and 26.2% of those participants taking furosemide.

Commenting on the findings of the study, study co-leader Robert J Mentz, MD, of Duke University Medical Center, Durham, North Carolina explained, “Overall, our study showed that torsemide did not improve survival compared to furosemide in this high-risk population of patients with heart failure, and we also observed similar rates of hospitalization with the two medications.”

Mentz continued, “We’re not saying that patients don’t need diuretics. We’re saying that there’s no difference in the survival benefit of these two therapies. This suggests we should be spending more time focusing on the right diuretic dose for our patients and working to treat patients with therapies that improve clinical outcomes in heart failure.”

Patrice Desvigne-Nickens, MD, study co-author and a medical officer in the Heart Failure and Arrhythmias Branch in National Heart, Lung, and Blood Institute (NHLBI)’s Division of Cardiovascular Sciences expounded, “This study represents an important step in understanding how heart failure treatments affect all groups and may help reduce health disparities associated with this condition”.