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Torsemide versus furosemide in heart failure patients: A meta-analysis of randomized controlled trials

Published:August 31, 2018DOI:https://doi.org/10.1016/j.ejim.2018.08.015
      In 2012, total cost for heart failure (HF) was $30.7 billion and by 2030, it is projected to increase to $69.7 billion [
      • Mozaffarian D.
      • Benjamin E.L.
      • Go A.S.
      • Arnett D.K.
      • Blaha M.J.
      • Cushman M.
      • et al.
      Executive Summary: Heart Disease and Stroke Statistics-2016 Update.
      ]. Hospitalizations for HF are a major reason for increased cost burden [
      • Buggey J.
      • Mentz R.J.
      • Pitt B.
      • Eisenstein E.L.
      • Anstrom K.J.
      • Velasquez E.
      • et al.
      A reappraisal of loop diuretic choice in heart failure patients.
      ]. Loop diuretics are a part of standard therapy in symptomatic HF patients to decrease hospitalizations. Data from small randomized trials and observational studies have shown superiority of torsemide in reducing HF hospitalizations compared to furosemide [
      • Stroupe K.T.
      • Forthofer M.M.
      • Brater D.C.
      • Murray M.D.
      Healthcare costs of patients with Heart failure Treated with Torsemide or Furosemide.
      ,
      • Murray M.D.
      • Deer M.M.
      • Ferguson J.A.
      • Dexter P.R.
      • Bennett S.J.
      • Perkins S.M.
      • et al.
      Open-label Randomized Trial of Torsemide compared with Furosemide for patients with Heart failure.
      ,
      • Muller K.
      • Gamba G.
      • Jaquet F.
      • Hess B.
      Torsemide vs. furosemide in primary care patients with chronic heart failure NYHA II to IV-efficacy and quality of life.
      ,
      • Mentz R.J.
      • Hasselblad V.
      • Devore A.
      • Metra M.
      • Voors A.A.
      • Armstrong P.W.
      • et al.
      Torsemide versus Furosemide in patients with Acute Heart failure (from the ASCEND-HF Trial).
      ,
      • Mentz R.J.
      • Velasquez E.J.
      • Metra M.
      • McKendry C.
      • Chiswell K.
      • Fiuzat M.
      • et al.
      Comparative effectiveness of torsemide versus furosemide in heart failure patients: insights from the PROTECT trial.
      ,
      • Mentz R.J.
      • Buggey J.
      • Fiuzat M.
      • Ersboll M.K.
      • Schulte P.J.
      • Devore A.D.
      • et al.
      Torsemide versus Furosemide in Heart failure patients: Insights from Duke University Hospital.
      ]. Despite that, >80% HF patients are on furosemide and < 10% are on torsemide [
      • Mentz R.J.
      • Hasselblad V.
      • Devore A.
      • Metra M.
      • Voors A.A.
      • Armstrong P.W.
      • et al.
      Torsemide versus Furosemide in patients with Acute Heart failure (from the ASCEND-HF Trial).
      ,
      • Mentz R.J.
      • Velasquez E.J.
      • Metra M.
      • McKendry C.
      • Chiswell K.
      • Fiuzat M.
      • et al.
      Comparative effectiveness of torsemide versus furosemide in heart failure patients: insights from the PROTECT trial.
      ,
      • Mentz R.J.
      • Buggey J.
      • Fiuzat M.
      • Ersboll M.K.
      • Schulte P.J.
      • Devore A.D.
      • et al.
      Torsemide versus Furosemide in Heart failure patients: Insights from Duke University Hospital.
      ]. Hence, we performed a meta-analysis of randomized controlled trials (RCTs) comparing torsemide and furosemide in HF.

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