Torsemide versus furosemide in patients with heart failure: a systematic review and updated meta-analysis of randomised controlled trials

Abstract

Abstract Background Furosemide is the most widely used diuretic for the management of heart failure (HF). However, the results of recent randomised controlled trials (RCTs) suggest that torsemide may be superior to furosemide in this setting. Purpose We aimed to compare the efficacy of torsemide versus furosemide in patients with HF. Methods We systematically searched PubMed, Scopus, and Cochrane Library for randomised controlled trials (RCTs) comparing torsemide with furosemide in patients with HF until February 2023 in accordance with PRISMA guidelines. Our outcomes of interest were all-cause mortality, hospitalisations for HF, and improvement in NYHA class. Review Manager software version 5.4.1 was used for statistical analyses. Between-study heterogeneity was assessed using I2 statistics. Results We included nine RCTs comprising 8270 patients with HF, of whom 2529 (30%) were randomised to torsemide. Mean follow-up ranged from 32 weeks to 17.4 years. In the pooled analysis, there was no significant difference between groups in terms of all-cause mortality (OR 0.98; 95% CI 0.85–1.13; p = 0.77; I2 = 0; Fig. 1A), hospitalizations for HF (OR 0.78; 95% CI 0.48–1.27; p = 0.32; I2 = 48; Fig. 1B), or improvement in NYHA class (OR 1.39; 95% CI 0.91–2.12; p = 0.13; I2 = 0; Fig. 1C). Conclusion In this meta-analysis, no significant difference was observed between torsemide and furosemide in managing HF with regards to all-cause mortality, hospitalisations for HF, or NYHA class improvement.Figure 1