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Torsemide versus furosemide and intermediate-term outcomes in patients with heart failure

an updated meta-analysis

Miles, Jeremy A.a; Hanumanthu, Balaram K.a; Patel, Kavishab; Chen, Michellea; Siegel, Robert M.a; Kokkinidis, Damianos G.a

Journal of Cardiovascular Medicine: June 2019 - Volume 20 - Issue 6 - p 379–388
doi: 10.2459/JCM.0000000000000794
Research articles: Heart failure

Aims Loop diuretics have become a mainstay of chronic heart failure management. Furosemide and torsemide are the two most common loop diuretics; nevertheless, there is inconsistent evidence regarding the optimal choice of loop diuretic with respect to clinical outcomes.

Methods Medline and Cochrane Databases were systemically reviewed for randomized and observational studies comparing patients with chronic heart failure on oral torsemide versus oral furosemide and their association with intermediate-term outcomes (5–12 months) through May 2018. Odds ratios with corresponding 95% confidence intervals (CIs) were used for outcomes. A random effect model was used to account for heterogeneity among studies. Heterogeneity was assessed with the Higgins I-square statistic.

Results A total of 8127 patients were included in the analysis from a total of 14 studies (10 randomized, four observational); 5729 patients were prescribed furosemide and 2398 were given torsemide. There was no significant difference in intermediate-term mortality among heart failure patients on furosemide compared with torsemide [odds ratio (OR) 1.01, CI 0.64–1.59, I2 = 65.8%]; however, furosemide was associated with an increased risk of heart failure readmissions (OR 2.16, CI 1.28–2.64, I2 = 0.0%). Heart failure patients taking torsemide were more likely to have an improvement in New York Heart Association class compared with those on furosemide (OR 0.73, CI 0.58–0.93, I2 = 19.6%).

Conclusion Torsemide is associated with a reduction in intermediate-term heart failure readmissions and improvement in New York Heart Association class compared with furosemide but is not associated with a reduced mortality risk. Additional randomized trials are needed to examine the impact of loop diuretics on clinical outcomes in patients with heart failure.

aDepartment of Medicine, Jacobi Medical Center

bDepartment of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA

Correspondence to Jeremy A. Miles, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Pkwy S, Bronx, New York, NY 10461, USA Tel: +1 718 918 5700; fax: +1 718 918 4598; e-mail:

Received 17 January, 2019

Revised 22 February, 2019

Accepted 9 March, 2019

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© 2019 Italian Federation of Cardiology. All rights reserved.