Torsemide Comparison With Furosemide for Management of Heart Failure - TRANSFORM-HF

Contribution To Literature:

Highlighted text has been updated as of June 13, 2023.

The TRANSFORM-HF trial failed to show that torsemide was superior to furosemide in improving survival among patients treated for decompensated heart failure.


The goal of the trial was to evaluate furosemide compared with torsemide after hospitalization for decompensated heart failure.

Study Design

  • Randomized
  • Parallel
  • Open-label

Patients hospitalized with decompensated heart failure were randomized to furosemide (n = 1,428) vs. torsemide (n = 1,431) after discharge.

  • Total number of enrollees: 2,859
  • Median duration of follow-up: 17.4 months
  • Mean patient age: 64 years
  • Percentage female: 37%

Inclusion criteria:

  • Patients hospitalized with decompensated heart failure regardless of ejection fraction

Principal Findings:

The primary outcome, all-cause mortality, occurred in 26.2% of the furosemide group vs. 26.1% of the torsemide group (p = 0.76).

Secondary outcomes:

  • All-cause mortality or hospitalization: 49.3% of the furosemide group vs. 47.3% of the torsemide group (p = 0.11)

Patient-reported quality of life at 12 months: No significant difference between torsemide vs. furosemide in change from baseline Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) (adjusted mean difference, 0.06; p = 0.96).


Among patients admitted with decompensated heart failure, post-discharge management with torsemide was not superior to furosemide. All-cause mortality and patient-reported quality of life were similar between treatment groups. Either furosemide or torsemide are acceptable options for diuresis among patients with heart failure.


Greene SJ, Velazquez EJ, Anstrom KJ, et al., on behalf of the TRANSFORM-HF Investigators. Effect of Torsemide vs Furosemide on Symptoms and Quality of Life Among Patients Hospitalized for Heart Failure: The TRANSFORM-HF Randomized Clinical Trial. Circulation 2023;148:124-34.

Mentz RJ, Anstrom KJ, Eisenstein EL, et al. Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure: The TRANSFORM-HF Randomized Clinical Trial. JAMA 2023;329:214-23.

Editorial: Kittleson MM. TRANSFORM-HF—Can We Close the Loop on Diuretics in Heart Failure? JAMA 2023;329:211-3.

Presented by Dr. Robert J. Mentz at the American Heart Association Scientific Sessions, Chicago, IL, November 5, 2022.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Statins, Acute Heart Failure

Keywords: AHA Annual Scientific Sessions, AHA22, Diuresis, Furosemide, Heart Failure, Patient Discharge, Quality of Life, Stroke Volume, Torsemide

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