Open-label randomized trial of torsemide compared with furosemide therapy for patients with heart failure

PURPOSE: Because the bioavailability of oral furosemide is erratic and ofte n incomplete, we tested the hypothesis that patients with heart failure who were treated with torsemide, a predictably absorbed diuretic, would have m ore favorable clinical outcomes than would those treated with furosemide. PATIENTS AND METHODS: We conducted an open-label trial of 234 patients with chronic heart failure (mean [+/- SD] age, 64 +/- 11 years) from an urban p ublic health care system. Patients received oral torsemide (n = 113) or fur osemide (n = 121) for I year. The primary endpoint was readmission to the h ospital for heart failure. Secondary endpoints included readmission for all cardiovascular causes and for all causes, numbers of hospital days, and he alth-related quality of life. RESULTS: Compared with furosemide-treated patients, torsemide-treated patie nts were less likely to need readmission for heart failure (39 [32%] vs. 19 [17%], P < 0.01) or for all cardiovascular causes (71 [59%] vs. 50 [44%], P = 0.03). There was no difference in the rate of admissions for all causes (92 [76%] vs. 80 [71%], P = 0.36). Patients treated with torsemide had sig nificantly fewer hospital days for heart failure (106 vs. 296 days, P = 0.0 2). Improvements in dyspnea and fatigue scores from baseline were greater a mong patients treated with torsemide, but the differences were statisticall y significant only for fatigue scores at months 2, 8, and 12. CONCLUSIONS: Compared with furosemide-treated patients, torsemide- treated patients were less likely to be readmitted for heart failure and for all ca rdiovascular causes, and were less fatigued. If our results are confirmed b y blinded trials, torsemide may be the preferred loop diuretic for patients with chronic heart failure. (C) 2001 by Excerpta Medica, Inc.