Meta-Analysis Comparing Torsemide Versus Furosemide in Patients With Heart Failure.

TLDR: Torsemide use was associated with significant more improvement in functional status and lower cardiac mortality; and numerically fewer hospitalizations in patients with heart failure; and there was no difference in all-cause mortality or medication side effects between the 2 groups.

Abstract: While torsemide's oral bioavailability and half-life theoretically render it a more efficient diuretic than furosemide, the clinical outcomes of torsemide compared with furosemide remain unclear. We performed a systematic review and meta-analysis, including all published studies that compared torsemide and furosemide use in heart failure patients from January 1996 through August 2019. Nineteen studies (9 randomized control trials (RCTs) and 10 observational studies) with a total of 19,280 patients were included. During a mean follow-up duration of 15 months, torsemide was associated with a numerically lower risk of hospitalization due to heart failure (10.6% vs. 18.4%; odds ratio (OR) 0.72, 95% confidence interval (CI) (0.51, 1.03), p=0.07, I2=18%; number needed to treat (NNT) =23) compared with furosemide. Torsemide was associated with statistically significant more improvement in functional status from New York Heart Association (NYHA) class III/IV to I/II (72.5% vs. 58%; OR 2.32, 95% CI (1.32, 4.1), p=0.004, I2=27%; NNT=5) and lower risk of cardiac mortality (1.5% vs. 4.4%; OR 0.37, 95% CI (0.20, 0.66), p