Torsemide vs. furosemide in congestive heart failure: a systematic-review and meta-analysis on mortality and rehospitalization

BACKGROUND: Current guidelines suggest the use of loop diuretics as the preferred agent for decongestion in patients with heart failure. However, there is no clear evidence as to superiority of one loop diuretic over the other. The understanding of pharmacokinetic and pharmacodynamic superiority of torsemide over furosemide has generated the hypothesis that these features could result in better clinical outcomes. OBJECTIVES: To determine whether the use of torsemide is associated with reduced risk for mortality and rehospitalizations in comparison to furosemide among patients with heart failure. METHODS: The study involves a comprehensive search of literature from PubMed, Cochrane CENTRAL, and ClinicalTrials.gov of clinical trials addressing the use of torsemide vs. furosemide in patients with heart failure. Pooled risk ratios (RR) were used to measure association for all outcomes with inverse-variance weighting and random effects model. RESULTS: The literature search included 188 studies that were screened individually. A total of 24 studies were identified out of which 12 were excluded. The pooled risk ratio (RR) revealed all-cause mortality of 0.98 [0.87 to 1.10] with 0% heterogeneity, all cause rehospitalization of 0.95 [0.88 to 1.02] with 5% heterogeneity, and heart failure rehospitalization of 0.85 [0.52 to 1.38] with 55% heterogeneity. CONCLUSION: Considering the evidence from pooled randomised trials, the use of torsemide compared to furosemide did not result in statistically significant differences in all-cause mortality or rehospitalization rates.