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Daily Dose: Comparison of Loop Diuretics Shows No Difference in Heart Failure Survival

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.


On January 18, 2023, we reported on a study published in JAMA that compared the effect of torsemide with furosemide in patients hospitalized with heart failure (HF).

The study

TRANSFORM-HF was an open-label, pragmatic randomized clinical trial of 2859 patients (median age, 65 years) who were hospitalized with HF at 60 medical centers across the US. Recruitment occurred from June 2018 to March 2022, with follow-up through 30 months for mortality and 12 months for hospitalizations. A total of 1431 participants were randomly assigned to receive torsemide and 1428 to receive furosemide.

Over a median follow-up of 17.4 months, 26.1% of patients in the torsemide group and 26.2% of those in the furosemide group died. All-cause mortality or all-cause hospitalization occurred in 677 patients (47.3%) in the torsemide group and 704 patients (49.3%) in the furosemide group over 12 months following randomization. There were 940 total hospitalizations among 536 participants (37.5%) in the torsemide group and 987 total hospitalizations among 577 participants (40.4%) in the furosemide group. The results were consistent across prespecified subgroups (eg, age, sex, race and ethnicity), including among participants with reduced, mildly reduced, or preserved ejection fraction.

Clinical implications

“Among patients discharged after hospitalization for heart failure, torsemide compared with furosemide did not result in a significant difference in all-cause mortality over 12 months. However, interpretation of these findings is limited by loss to follow-up and participant crossover and nonadherence."

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