Abstract 14698: Effect of Torsemide vs. Furosemide Among Patients With New Onset and Worsening Heart Failure: The Transform-HF Randomized Trial
KRIM, SR; Anand, S; Greene, SJ; CHEN, A; Wojdyla, D; Vilaro, J; Herbert, H; Herre, JM; Eisenstein, EL; Anstrom, K; Pitt, B; Velazquez, EJ; Mentz, RJ
Published in: Circulation
In the TRANSFORM HF trial, among patients discharged after hospitalization for heart failure (HF), torsemide compared with furosemide did not result in a significant difference in all-cause mortality over 12 months.
Differences in clinical profiles, outcomes, and treatment effects may exist between de-novo and worsening chronic HF (WHF) patients.
Using data from TRANSFORM-HF trial, we compared clinical characteristics, outcomes, and treatment effect of torsemide versus furosemide of patients hospitalized with de novo versus WHF. Endpoints included all-cause mortality and hospitalization outcomes over 12 months, as well as change from baseline in KCCQ-CSS.
Among 2,858 patients, 838 (29.3%) patients had de novo HF and 2,020 (70.7%) patients had WHF. Irrespective of ejection fraction phenotype, de novo HF patients were younger, had a higher GFR and lower levels of natriuretic peptides. In contrast, a higher discharge diuretic dose along with a higher use of nitrate/hydralazine was noted among WHF patients. De novo HF was associated with lower all-cause mortality (de novo 13.7% vs. WHF 31.3%; adjusted hazard ratio: 0.53; 95%CI [0.43-0.66]; p<0.001). Similarly, lower all-cause first re-hospitalization (de novo 30.3% vs. WHF 42.5%; adjusted hazard ratio: 0.72; 95%CI [0.64-0.81]; p<0.001) and greater improvement in KCCQ-CSS at 12 months (de novo 29.9 vs. WHF 23.7; adjusted estimated difference in means: 6.3; 95%CI [3.7-8.8]; p<0.001) were noted among de novo HF patients. No significant differences in mortality or hospitalizations were noted with torsemide versus furosemide in either de novo or WHF (Figure).
Among patients discharged with acute HF, de novo HF was associated with better outcomes when compared to WHF. Regardless of de novo vs WHF status, there was no significant difference between torsemide and furosemide with respect to 12-month clinical or patient-reported outcomes.
