Comparative analysis of furosemide and torsemide efficacy in 24 hours of acute heart failure admission

TL;DR

This study compared furosemide and torsemide in treating acute heart failure and found both drugs to be similarly effective within 24 hours.

Contribution

The study provides direct comparative evidence of furosemide and torsemide efficacy in acute heart failure treatment.

Findings

Furosemide and torsemide showed similar changes in urinary sodium levels after 24 hours.

Both drugs reduced lung congestion and dyspnea similarly based on clinical and ultrasound assessments.

Furosemide had a slightly higher urine output, but the difference was not statistically significant.

Abstract

Intravenous (IV) furosemide and torsemide represent a cornerstone of guideline-directed medical therapy for acute heart failure (AHF). However, the evidence regarding the superiority of each agent remains controversial.

The prospective, open-label, comparative study included 51 adult patients hospitalized due to AHF. Torsemide was administered to 25 patients (49%), and furosemide to 26 patients (51%). The primary endpoint was the change in urinary spot sodium level at 24 h, used to assess diuretic efficacy. Secondary outcomes included lung ultrasound (LUS) B-lines, clinical status evaluation based on the Borg scale, Killip-Kimball classification, and daily urine output.

After 24 h of treatment, urinary sodium levels increased by an estimated marginal mean (EMM) of 21.84 mmol/L in the furosemide group and 0.97 mmol/L in the torsemide group (p = 0.173). The number of B-lines over 24 h decreased, with an EMM of 28.31 in the furosemide group, and 30.12 in the torsemide group (p = 0.779). The severity of dyspnea, measured by the Borg scale, decreased over 24 h with an EMM of 3.58 points in the furosemide group, and 3.62 points in the torsemide group (p = 0.891). Pulmonary congestion, measured by the Killip-Kimball classification, minimized with an EMM of 0.42 points in the furosemide group, and 0.47 points in the torsemide group (p = 0.770). Daily urine output after 24 h of treatment reached an EMM of 3,559.67 mL in the furosemide group, and 2,734.89 mL in the torsemide group (p = 0.068).

Both furosemide and torsemide demonstrated comparable efficacy in the initial treatment of AHF, as assessed by laboratory, ultrasound, and clinical parameters.

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