Abstract
Purpose
Because the bioavailability of oral furosemide is erratic and often incomplete, we
tested the hypothesis that patients with heart failure who were treated with torsemide,
a predictably absorbed diuretic, would have more 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 public health care system. Patients received
oral torsemide (n = 113) or furosemide (n = 121) for 1 year. The primary endpoint
was readmission to the hospital for heart failure. Secondary endpoints included readmission
for all cardiovascular causes and for all causes, numbers of hospital days, and health-related
quality of life.
Results
Compared with furosemide-treated patients, torsemide-treated patients 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 significantly fewer hospital days for
heart failure (106 vs. 296 days, P = 0.02). Improvements in dyspnea and fatigue scores from baseline were greater among
patients treated with torsemide, but the differences were statistically 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 cardiovascular causes, and were less
fatigued. If our results are confirmed by blinded trials, torsemide may be the preferred
loop diuretic for patients with chronic heart failure.
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Article info
Publication history
Accepted:
June 27,
2001
Received:
January 10,
2001
Footnotes
☆Supported by NIH R01 DK37993 and R01 AG07631, and Roche Laboratories, Nutley, New Jersey. Dr. Murray has received travel reimbursement from Boehringer Mannheim Therapeutics, Mannheim, Germany. Dr. Brater has received travel reimbursement and honoraria from Hoechst, Sommerville, New Jersey, and from Roche Laboratories.
Identification
Copyright
© 2001 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
