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Effect of Torsemide Versus Furosemide on Symptoms and Quality of Life Among Patients Hospitalized for Heart Failure: The TRANSFORM-HF Randomized Clinical Trial.

Publication ,  Journal Article
Greene, SJ; Velazquez, EJ; Anstrom, KJ; Clare, RM; DeWald, TA; Psotka, MA; Ambrosy, AP; Stevens, GR; Rommel, JJ; Alexy, T; Ketema, F; Kim, D-Y ...
Published in: Circulation
July 11, 2023

BACKGROUND: Loop diuretics are a primary therapy for the symptomatic treatment of heart failure (HF), but whether torsemide improves patient symptoms and quality of life better than furosemide remains unknown. As prespecified secondary end points, the TRANSFORM-HF trial (Torsemide Comparison With Furosemide for Management of Heart Failure) compared the effect of torsemide versus furosemide on patient-reported outcomes among patients with HF. METHODS: TRANSFORM-HF was an open-label, pragmatic, randomized trial of 2859 patients hospitalized for HF (regardless of ejection fraction) across 60 hospitals in the United States. Patients were randomly assigned in a 1:1 ratio to a loop diuretic strategy of torsemide or furosemide with investigator-selected dosage. This report examined effects on prespecified secondary end points, which included Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS; assessed as adjusted mean difference in change from baseline; range, 0-100 with 100 indicating best health status; clinically important difference, ≥5 points) and Patient Health Questionnaire-2 (range, 0-6; score ≥3 supporting evaluation for depression) over 12 months. RESULTS: Baseline data were available for 2787 (97.5%) patients for KCCQ-CSS and 2624 (91.8%) patients for Patient Health Questionnaire-2. Median (interquartile range) baseline KCCQ-CSS was 42 (27-60) in the torsemide group and 40 (24-59) in the furosemide group. At 12 months, there was no significant difference between torsemide and furosemide in change from baseline in KCCQ-CSS (adjusted mean difference, 0.06 [95% CI, -2.26 to 2.37]; P=0.96) or the proportion of patients with Patient Health Questionnaire-2 score ≥3 (15.1% versus 13.2%: P=0.34). Results for KCCQ-CSS were similar at 1 month (adjusted mean difference, 1.36 [95% CI, -0.64 to 3.36]; P=0.18) and 6-month follow-up (adjusted mean difference, -0.37 [95% CI, -2.52 to 1.78]; P=0.73), and across subgroups by ejection fraction phenotype, New York Heart Association class at randomization, and loop diuretic agent before hospitalization. Irrespective of baseline KCCQ-CSS tertile, there was no significant difference between torsemide and furosemide on change in KCCQ-CSS, all-cause mortality, or all-cause hospitalization. CONCLUSIONS: Among patients discharged after hospitalization for HF, a strategy of torsemide compared with furosemide did not improve symptoms or quality of life over 12 months. The effects of torsemide and furosemide on patient-reported outcomes were similar regardless of ejection fraction, previous loop diuretic use, and baseline health status. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03296813.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 11, 2023

Volume

148

Issue

2

Start / End Page

124 / 134

Location

United States

Related Subject Headings

  • Torsemide
  • Stroke Volume
  • Sodium Potassium Chloride Symporter Inhibitors
  • Quality of Life
  • Humans
  • Heart Failure
  • Furosemide
  • Cardiovascular System & Hematology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences
 

Citation

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Greene, S. J., Velazquez, E. J., Anstrom, K. J., Clare, R. M., DeWald, T. A., Psotka, M. A., … TRANSFORM-HF Investigators, . (2023). Effect of Torsemide Versus Furosemide on Symptoms and Quality of Life Among Patients Hospitalized for Heart Failure: The TRANSFORM-HF Randomized Clinical Trial. Circulation, 148(2), 124–134. https://doi.org/10.1161/CIRCULATIONAHA.123.064842
Greene, Stephen J., Eric J. Velazquez, Kevin J. Anstrom, Robert M. Clare, Tracy A. DeWald, Mitchell A. Psotka, Andrew P. Ambrosy, et al. “Effect of Torsemide Versus Furosemide on Symptoms and Quality of Life Among Patients Hospitalized for Heart Failure: The TRANSFORM-HF Randomized Clinical Trial.Circulation 148, no. 2 (July 11, 2023): 124–34. https://doi.org/10.1161/CIRCULATIONAHA.123.064842.
Greene SJ, Velazquez EJ, Anstrom KJ, Clare RM, DeWald TA, Psotka MA, et al. Effect of Torsemide Versus Furosemide on Symptoms and Quality of Life Among Patients Hospitalized for Heart Failure: The TRANSFORM-HF Randomized Clinical Trial. Circulation. 2023 Jul 11;148(2):124–34.
Greene, Stephen J., et al. “Effect of Torsemide Versus Furosemide on Symptoms and Quality of Life Among Patients Hospitalized for Heart Failure: The TRANSFORM-HF Randomized Clinical Trial.Circulation, vol. 148, no. 2, July 2023, pp. 124–34. Pubmed, doi:10.1161/CIRCULATIONAHA.123.064842.
Greene SJ, Velazquez EJ, Anstrom KJ, Clare RM, DeWald TA, Psotka MA, Ambrosy AP, Stevens GR, Rommel JJ, Alexy T, Ketema F, Kim D-Y, Desvigne-Nickens P, Pitt B, Eisenstein EL, Mentz RJ, TRANSFORM-HF Investigators. Effect of Torsemide Versus Furosemide on Symptoms and Quality of Life Among Patients Hospitalized for Heart Failure: The TRANSFORM-HF Randomized Clinical Trial. Circulation. 2023 Jul 11;148(2):124–134.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 11, 2023

Volume

148

Issue

2

Start / End Page

124 / 134

Location

United States

Related Subject Headings

  • Torsemide
  • Stroke Volume
  • Sodium Potassium Chloride Symporter Inhibitors
  • Quality of Life
  • Humans
  • Heart Failure
  • Furosemide
  • Cardiovascular System & Hematology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences