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Comparative Analysis of Long-Term Outcomes of Torasemide and Furosemide in Heart Failure Patients in Heart Failure Registries of the European Society of Cardiology

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Abstract

Purpose

Current clinical recommendations do not emphasise superiority of any of diuretics, but available reports are very encouraging and suggest beneficial effects of torasemide. This study aimed to compare the effect of torasemide and furosemide on long-term outcomes and New York Heart Association (NYHA) class change in patients with chronic heart failure (HF).

Methods

Of 2019 patients enrolled in Polish parts of the heart failure registries of the European Society of Cardiology (Pilot and Long-Term), 1440 patients treated with a loop diuretic were included in the analysis. The main analysis was performed on matched cohorts of HF patients treated with furosemide and torasemide using propensity score matching.

Results

Torasemide was associated with a similar primary endpoint (all-cause death; 9.8% vs. 14.1%; p = 0.13) occurrence and 23.8% risk reduction of the secondary endpoint (a composite of all-cause death or hospitalisation for worsening HF; 26.4% vs. 34.7%; p = 0.04). Treatment with both torasemide and furosemide was associated with the significantly most frequent occurrence of the primary (23.8%) and secondary (59.2%) endpoints. In the matched cohort after 12 months, NYHA class was higher in the furosemide group (p = 0.04), while furosemide use was associated with a higher risk (20.0% vs. 12.9%; p = 0.03) of worsening ≥ 1 NYHA class. Torasemide use impacted positively upon the primary endpoint occurrence, especially in younger patients (aged < 65 years) and with dilated cardiomyopathy.

Conclusions

Our findings contribute to the body of research on the optimal diuretic choice. Torasemide may have advantageous influence on NYHA class and long-term outcomes of HF patients, especially younger patients or those with dilated cardiomyopathy, but it needs further investigations in prospective randomised trials.

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Funding

The study is financed from the statutory funds of the European Society of Cardiology (ESC).

Author information

Authors and Affiliations

  1. Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland

    Krzysztof Ozierański, Paweł Balsam, Agnieszka Kapłon-Cieślicka, Agata Tymińska, Robert Kowalik, Marcin Grabowski, Michał Peller, Anna Wancerz, Michał Marchel, Krzysztof J. Filipiak & Grzegorz Opolski

  2. Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario A Coruna, CIBERCV, La Coruna, Spain

    Maria G. Crespo-Leiro

  3. ANMCO Research Centre, Florence, Italy

    Aldo P. Maggioni

  4. EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France

    Aldo P. Maggioni

  5. Department of Cardiology, Cardiology and Cardiac Surgery, Medical University of Lodz, Lodz, Poland

    Jarosław Drożdż

Authors
  1. Krzysztof Ozierański
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  2. Paweł Balsam
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  3. Agnieszka Kapłon-Cieślicka
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  8. Anna Wancerz
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  11. Aldo P. Maggioni
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  12. Jarosław Drożdż
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  14. Grzegorz Opolski
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Contributions

KO conceived of the idea for the study and performed the statistical analysis. KO and PB designed the analysis, conducted the data interpretation and wrote the manuscript. KO, PB, AKC, AT, RK, MG, MP, AW and MM researched the data. KJF and GO reviewed the manuscript. MGCL and APM designed and coordinated the registries. JD coordinated the registry nationwide. All authors edited and approved the final version of the manuscript.

Corresponding author

Correspondence to Paweł Balsam.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ozierański, K., Balsam, P., Kapłon-Cieślicka, A. et al. Comparative Analysis of Long-Term Outcomes of Torasemide and Furosemide in Heart Failure Patients in Heart Failure Registries of the European Society of Cardiology. Cardiovasc Drugs Ther 33, 77–86 (2019). https://doi.org/10.1007/s10557-018-6843-5

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