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Am J Cardiol. 2020 Jan 1;125(1):92-99. doi: 10.1016/j.amjcard.2019.09.039. Epub 2019 Oct 10.

Meta-Analysis Comparing Torsemide Versus Furosemide in Patients With Heart Failure.

Author information

1
Department of Medicine, Ascension Saint John Hospital, Detroit, Michigan. Electronic address: bisho.abraham@gmail.com.
2
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiovascular Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota.
3
Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, Illinois.
4
Department of Internal Medicine, Saint Joseph University Medical Center, Paterson, New Jersey.
5
Department of Cardiovascular Medicine, University of Arkansas for MedicalSciences, Little Rock, Arkansas; Department of Cardiology, Ain Shams University Hospitals, Cairo, Egypt.
6
Division of Nephrology, Department of Medicine, Ascension Saint John Hospital, Detroit, Michigan.
7
Division of Cardiovascular Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota.
8
Division of Cardiovascular Medicine, Department of Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota.
9
Division of Cardiology, Department of Medicine, Ascension Saint John Hospital, Detroit, Michigan.
10
Department of Medicine, Ascension Saint John Hospital, Detroit, Michigan.

Abstract

Although torsemide's oral bioavailability and half-life theoretically render it a more efficient diuretic than furosemide, the clinical outcomes of torsemide compared with furosemide remain unclear. We performed a systematic review and meta-analysis, including all published studies that compared torsemide and furosemide use in heart failure patients from January 1996 through August 2019. Nineteen studies (9 randomized control trials [RCTs] and 10 observational studies) with a total of 19,280 patients were included. During a mean follow-up duration of 15 months, torsemide was associated with a numerically lower risk of hospitalization due to heart failure (10.6% vs 18.4%; odds ratio [OR] 0.72, 95% confidence interval [CI] [0.51, 1.03], p = 0.07, I2 = 18%; number needed to treat [NNT] = 23) compared with furosemide. Torsemide was associated with statistically significant more improvement in functional status from New York Heart Association (NYHA) class III/IV to I/II (72.5% vs 58%; OR 2.32, 95% CI (1.32, 4.1), p = 0.004, I2 = 27%; NNT = 5) and lower risk of cardiac mortality (1.5% vs 4.4%; OR 0.37, 95% CI (0.20, 0.66), p <0.001, I2 = 0%, NNT = 40) compared with furosemide. However, there was no difference in all-cause mortality or medication side effects between the 2 groups. In conclusion, compared with furosemide, torsemide use was associated with significant more improvement in functional status and lower cardiac mortality; and numerically fewer hospitalizations in patients with heart failure.

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