1
|
Virkud AV, Chang PP, Funk MJ, Kshirsagar AV, Edwards JK, Pate V, Kosorok MR, Gower EW. Comparative Effect of Loop Diuretic Prescription on Mortality and Heart Failure Readmission. Am J Cardiol 2024; 210:208-216. [PMID: 37972425 DOI: 10.1016/j.amjcard.2023.08.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 11/19/2023]
Abstract
Loop diuretics are a standard pharmacologic therapy in heart failure (HF) management. Although furosemide is most frequently used, torsemide and bumetanide are increasingly prescribed in clinical practice, possibly because of superior bioavailability. Few real-world comparative effectiveness studies have examined outcomes across all 3 loop diuretics. The study goal was to compare the effects of loop diuretic prescribing at HF hospitalization discharge on mortality and HF readmission. We identified patients in Medicare claims data initiating furosemide, torsemide, or bumetanide after an index HF hospitalization from 2007 to 2017. We estimated 6-month risks of all-cause mortality and a composite outcome (HF readmission or all-cause mortality) using inverse probability of treatment weighting to adjust for relevant confounders. We identified 62,632 furosemide, 1,720 torsemide, and 2,389 bumetanide initiators. The 6-month adjusted all-cause mortality risk was lowest for torsemide (13.2%), followed by furosemide (14.5%) and bumetanide (15.6%). The 6-month composite outcome risk was 21.4% for torsemide, 24.7% for furosemide, and 24.9% for bumetanide. Compared with furosemide, the 6-month all-cause mortality risk was 1.3% (95% confidence interval [CI]: -3.7, 1.0) lower for torsemide and 1.0% (95% CI: -1.2, 3.2) higher for bumetanide, and the 6-month composite outcome risk was 3.3% (95% CI: -6.3, -0.3) lower for torsemide and 0.2% (95% CI: -2.5, 2.9) higher for bumetanide. In conclusion, the findings suggested that the first prescribed loop diuretic following HF hospitalization is associated with clinically important differences in morbidity in older patients receiving torsemide, bumetanide, or furosemide. These differences were consistent for the effect of all-cause mortality alone, but were not statistically significant.
Collapse
Affiliation(s)
- Arti V Virkud
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Patricia P Chang
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michele Jonsson Funk
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Abhijit V Kshirsagar
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Virginia Pate
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily W Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
2
|
Singh S, Goel S, Duhan S, Chaudhary R, Garg A, Tantry US, Gurbel PA. Effect of Furosemide Versus Torsemide on Hospitalizations and Mortality in Patients With Heart Failure: A Meta-Analysis of Randomized Controlled Trials. Am J Cardiol 2023; 206:42-48. [PMID: 37677884 PMCID: PMC10824237 DOI: 10.1016/j.amjcard.2023.08.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023]
Abstract
Loop diuretics are essential in the treatment of patients with heart failure (HF) who develop congestion. Furosemide is the most commonly used diuretic; however, some randomized controlled trials (RCTs) have shown varying results associated with torsemide and furosemide in terms of hospitalizations and mortality. We performed an updated meta-analysis of currently available RCTs comparing furosemide and torsemide to see if there is any difference in clinical outcomes in patients treated with these loop diuretics. PubMed, MEDLINE, Cochrane, and Embase databases were searched for RCTs comparing the outcomes in patients with HF treated with furosemide versus torsemide. The primary end points included all-cause mortality, all-cause hospitalizations, cardiovascular-related hospitalizations, and HF-related hospitalizations. A random-effects meta-analysis was performed to estimate the risk ratio (RR) with a 95% confidence interval (CI). A total of 10 RCTs with 4,127 patients (2,088 in the furosemide group and 2,039 in the torsemide group) were included in this analysis. A total of 56% of the patients were men and the mean age was 68 years. No significant difference was noted in all-cause mortality between the furosemide and torsemide groups (RR 1.02, 95% CI 0.91 to 1.15, p = 0.70); however, patients treated with furosemide compared with torsemide had higher risks of cardiovascular hospitalizations (RR 1.36, 95% CI 1.13 to 1.65, p = 0.001), HF-related hospitalizations (RR 1.65, 95% CI 1.21 to 2.24, p = 0.001), and all-cause hospitalizations (RR 1.06, 95% CI 1.01 to 1.11, p = 0.02). In conclusion, patients with HF treated with torsemide have a reduced risk of hospitalizations compared with those treated with furosemide, without any difference in mortality. These data indicate that torsemide may be a better choice to treat patients with HF.
Collapse
Affiliation(s)
- Sahib Singh
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland.
| | - Swecha Goel
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sanchit Duhan
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Rahul Chaudhary
- Division of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Aakash Garg
- Cardiology Associates of Schenectady, St. Peter's Health Partners, Albany, New York
| | - Udaya S Tantry
- Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Paul A Gurbel
- Sinai Center for Thrombosis Research, Sinai Hospital of Baltimore, Baltimore, Maryland; Division of Cardiology, Sinai Hospital of Baltimore, Baltimore, Maryland
| |
Collapse
|
3
|
Siddiqi AK, Javaid H, Ahmed M, Dhawadi S, Batool L, Zahid M, Muslim MO, Naeem K, Mahmood F, Hussain A. Clinical Outcomes With Furosemide Versus Torsemide in Patients With Heart Failure: An Updated Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101927. [PMID: 37453532 DOI: 10.1016/j.cpcardiol.2023.101927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Despite potential advantages of torsemide over furosemide, <10% of the patients with heart failure (HF) are on torsemide in clinical practice. Prior studies comparing furosemide to torsemide in patients with HF have shown conflicting findings, regarding hospitalizations and mortality. We aimed to pool all the studies conducted to date and provide the most updated and comprehensive evidence, regarding the effect of furosemide vs torsemide in reducing mortality and hospitalizations in patients with HF. We conducted a comprehensive literature search of the PubMed/Medline, Cochrane Library and Scopus from inception till June 2023, for randomized and nonrandomized studies comparing furosemide to torsemide in adult patients (>18 years) with acute or chronic HF. Data about all-cause mortality, HF-related hospitalizations and all-cause hospitalizations was extracted, pooled, and analyzed. Forest plots were created based on the random effects model. A total of 17 studies (n = 11,996 patients) were included in our analysis with a median follow-up time of 8 months. Our pooled analysis demonstrated no difference in all-cause mortality between furosemide and torsemide groups in HF patients (OR = 0.98, 95% CI: 0.75-1.29, P = 0.89). However, torsemide was associated with a significantly lesser incidence of HF-related hospitalizations (OR = 0.73, 95% CI: 0.54-0.99, P = 0.04), and all-cause hospitalizations (OR = 0.84, 95% CI: 0.73-0.98, P = 0.03), as compared to furosemide. Torsemide significantly reduces HF-related and all-cause hospitalizations as compared to furosemide, with no difference in mortality. We recommend transitioning from furosemide to torsemide in HF patients who are not attaining symptomatic control.
Collapse
Affiliation(s)
| | - Hira Javaid
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Mushood Ahmed
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Siwar Dhawadi
- Department of Medicine, Faculty of Medicine Monastir, Mosastir, Tunisia
| | - Laiba Batool
- Department of Medicine, CMH Institute of Medical Sciences, Multan, Pakistan
| | - Maheen Zahid
- Department of Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | | | - Khadija Naeem
- Department of Medicine, Nishtar Medical University, Multan, Pakistan
| | - Fizza Mahmood
- Department of Medicine, Quaid-E-Azam Medical College, Bahawalpur, Pakistan
| | - Abbas Hussain
- Department of Medicine, Jinnah Medical and Dental College, Karachi, Pakistan
| |
Collapse
|
4
|
Chopra VK, Mohanan PP, Kher V, Mantri RR, Isaacs R, Jadhav U, Zalte N, Sugumaran A, Mohanasundaram S. The Potential Role of Torsemide in Optimizing Loop Diuretic Therapy for Heart Failure Patients. Cureus 2023; 15:e41957. [PMID: 37588313 PMCID: PMC10426810 DOI: 10.7759/cureus.41957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/18/2023] Open
Abstract
Heart failure is associated with an increased frequency of hospitalization, reduced life span, and greater risk to public health, thus posing a challenge. In India, torsemide is one of the commonly used loop diuretics for decongestion in heart failure. However, this use of torsemide, including its dosing, and up/down titration, is based on practical experience. Loop diuretic therapy for heart failure patients poses several dilemmas due to the lack of robust evidence based on which treatment decisions can be made. To guide physicians on the optimal use of torsemide in heart failure patients with or without renal impairment, a panel of expert cardiologists and nephrologists from India convened to develop this expert opinion document for the use of torsemide. This expert opinion on torsemide will pave the way for optimal management with loop diuretic therapy in real-world heart failure patients.
Collapse
Affiliation(s)
- V K Chopra
- Clinical Cardiology Heart Failure and Research, Max Super Speciality Hospital, New Delhi, IND
| | - P P Mohanan
- Cardiology, Westfort Hi-Tech Hospital, Thrissur, IND
| | - Vijay Kher
- Nephrology, Medanta Kidney and Urology Institute, Gurugram, IND
| | | | - Rajan Isaacs
- Nephrology, Deep Kidney Care Centre, Ludhiana, IND
| | - Uday Jadhav
- Cardiology, Mahatma Gandhi Mission (MGM) New Bombay Hospital, Navi Mumbai, IND
| | | | | | | |
Collapse
|
5
|
[Acute heart failure and cardiogenic shock : An update]. Herz 2023; 48:95-100. [PMID: 36695879 DOI: 10.1007/s00059-022-05159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Abstract
Acute heart failure is a clinical syndrome resulting from elevated intracardiac filling pressures and a systemic venous congestion. In general, patients can present acutely without a history of structural cardiac disease (de novo heart failure) or with acute worsening of a pre-existing dysfunction of the right or left ventricle. The patient population is overall very inhomogeneous and as a result there is also a distinct heterogeneity with respect to the underlying cardiac pathology that leads to the acute presentation. Ultimately, ventricular dysfunction leads to increased preload and afterload resulting in decreased perfusion and retrograde congestion. The forward failure (hypoperfusion) and backwards failure (systemic congestion) can lead to impaired end organ function or even organ failure resulting in cardiogenic shock, in which sufficient organ and tissue perfusion is no longer possible. Consequently, therapeutic strategies currently focus on rectification of the underlying cardiac dysfunction, reduction of volume overload (decongestion) and hemodynamic stabilization with drugs supporting the circulation in the case of a hypoperfusion syndrome. Despite numerous new therapeutic strategies within the last two decades, the empirical data based on randomized trials is considerably less solid than in chronic heart failure, which is expressed in the almost unchanged 1‑year mortality of approximately 20-30%.
Collapse
|
6
|
Imaeda S, Shiraishi Y, Kohsaka S, Niimi N, Goda A, Nagatomo Y, Takei M, Saji M, Nakano S, Kohno T, Fukuda K, Yoshikawa T. Use of short-acting vs. long-acting loop diuretics after heart failure hospitalization. ESC Heart Fail 2022; 9:2967-2977. [PMID: 35730147 DOI: 10.1002/ehf2.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/05/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS Furosemide, a short-acting loop diuretic (SD), is the dominant agent prescribed for heart failure (HF) in clinical practice. However, accumulating data suggests that long-acting loop diuretics (LD), such as torsemide or azosemide, might have more favourable pharmacological profiles. This study aimed to investigate the relationship between the type of loop diuretics and long-term outcomes among patients hospitalized for acute HF enrolled in a contemporary multicentre registry. METHODS AND RESULTS Within the West Tokyo Heart Failure Registry from 2006 to 2017, a total of 2680 patients (60.1% men with a median age of 77 years) were analysed. The patients were characterized by the type of diuretics used at the time of discharge; 2073 (77.4%) used SD, and 607 (22.6%) used LD. The primary endpoint was composite of all-cause death or HF re-admission after discharge, and the secondary endpoints were all-cause death and HF re-admission, respectively. During the median follow-up period of 2.1 years, 639 patients died [n = 519 (25.0%) in the SD group; n = 120 (19.8%) in the LD group], and 868 patients were readmitted for HF [n = 697 (33.6%) in the SD group; n = 171 (28.2%) in the LD group]. After multivariable adjustment, the LD group had lower risk for the composite outcome [hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.66-0.96; P = 0.017], including all-cause death (HR; 0.73; 95% CI; 0.54-0.99; P = 0.044) and HF re-admission (HR, 0.81; 95% CI, 0.66-0.99; P = 0.038), than the SD group. Propensity score matching yielded estimates that were consistent with those of the multivariable analyses, with sub-group analyses demonstrating that use of LD was associated with favourable outcomes predominantly in younger patients with reduced ejection fraction. CONCLUSIONS LD was associated with lower risk of long-term outcomes in patients with HF and a recent episode of acute decompensation.
Collapse
Affiliation(s)
- Shohei Imaeda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Niimi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University Fuculty of Medicine, Tokyo, Japan
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Fuculty of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | |
Collapse
|
7
|
Cooper LB, Bruce S, Psotka M, Mentz R, Bell R, Seliger SL, O'Connor C, deFilippi C. Proteomic differences among patients with heart failure taking furosemide or torsemide. Clin Cardiol 2022; 45:265-272. [PMID: 35014074 PMCID: PMC8922525 DOI: 10.1002/clc.23733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/13/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Loop diuretics are commonly used for patients with heart failure (HF) but it remains unknown if one loop diuretic is clinically superior. HYPOTHESIS Biomarkers and proteomics provide insight to how different loop diuretics may differentially affect outcomes. METHODS Blood and urine were collected from outpatients with HF who were taking torsemide or furosemide for >30 days. Differences were assessed in cardiac, renal, and inflammatory biomarkers and soluble protein panels using the Olink Cardiovascular III and inflammation panels. RESULTS Of 78 subjects, 55 (71%) were treated with furosemide and 23 (29%) with torsemide, and 25 provided a urine sample (15 treated with furosemide, 10 with torsemide). Patients taking torsemide were older (68 vs 64 years) with a lower mean eGFR (46 vs 54 ml/min/1.73 m2 ), a higher proportion were women (39% vs 24%) and Black (43% vs 27%). In plasma, levels of hs-cTnT, NT-proBNP, and hsCRP were not significantly different between groups. In urine, there were significant differences in urinary albumin, β-2M, and NGAL, with higher levels in the torsemide-treated patients. Of 184 proteins testing in Olink panels, in plasma, 156 (85%) were higher in patients taking torsemide but none were significantly different after correcting for false discovery. CONCLUSIONS We show differences in urinary biomarkers but few differences in plasma biomarkers among HF patients on different loop diuretics. Olink technology can detect differences in plasma protein levels from multiple biologic domains. These findings raise the importance of defining differences in mechanisms of action of each diuretic in an appropriately powered study.
Collapse
Affiliation(s)
- Lauren B Cooper
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.,Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Scott Bruce
- Department of Statistics, Volgenau School of Engineering, George Mason University, Fairfax, Virginia, USA
| | - Mitchell Psotka
- Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Robert Mentz
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel Bell
- Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Stephen L Seliger
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Christopher O'Connor
- Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Christopher deFilippi
- Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia, USA
| |
Collapse
|
8
|
Dixit NM, Shah S, Ziaeian B, Fonarow GC, Hsu JJ. Optimizing Guideline-directed Medical Therapies for Heart Failure with Reduced Ejection Fraction During Hospitalization. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2020.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Heart failure remains a huge societal concern despite medical advancement, with an annual direct cost of over $30 billion. While guideline-directed medical therapy (GDMT) is proven to reduce morbidity and mortality, many eligible patients with heart failure with reduced ejection fraction (HFrEF) are not receiving one or more of the recommended medications, often due to suboptimal initiation and titration in the outpatient setting. Hospitalization serves as a key point to initiate and titrate GDMT. Four evidence-based therapies have clinical benefit within 30 days of initiation and form a crucial foundation for HFrEF therapy: renin-angiotensin-aldosterone system inhibitors with or without a neprilysin inhibitor, β-blockers, mineralocorticoid-receptor-antagonists, and sodium-glucose cotransporter-2 inhibitors. The authors present a practical guide for the implementation of these four pillars of GDMT during a hospitalization for acute heart failure.
Collapse
Affiliation(s)
- Neal M Dixit
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Shivani Shah
- Department of Pharmacy Services, Olive View-UCLA Medical Center, Los Angeles, CA
| | - Boback Ziaeian
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Gregg C Fonarow
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Jeffrey J Hsu
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Division of Cardiology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| |
Collapse
|
9
|
|
10
|
Eid PS, Ibrahim DA, Zayan AH, Elrahman MMA, Shehata MAA, Kandil H, Abouibrahim MA, Duy LM, Shinkar A, Elfaituri MK, Minh LHN, Fahmy MM, Tam DNH, Vuong NL, Shah J, Do VBD, Hirayama K, Huy NT. Comparative effects of furosemide and other diuretics in the treatment of heart failure: a systematic review and combined meta-analysis of randomized controlled trials. Heart Fail Rev 2020; 26:127-136. [PMID: 32783109 DOI: 10.1007/s10741-020-10003-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Diuretics have an essential role in the management of heart failure (HF). However, each drug has its own benefit and side effect. Side effects include fluid, electrolyte abnormalities, and acid-base disturbance. These adverse effects of diuretics predispose patients to serious cardiac arrhythmias and may increase the risk of arrhythmic mortality. Herein, we aim to summarize the relative efficacy and safety of all available diuretics used in the treatment of patients with HF. In June 2017, a systematic electronic database search was conducted in nine databases. All randomized controlled trials (RCTs) comparing the different diuretics used in HF were included for meta-analysis. The protocol was registered in Prospero with CRD42018084819. Among the included 54 studies (10,740 patients), 34 RCTs were eligible for quantitative network meta-analysis (NMA) and traditional meta-analysis while the other 20 studies were qualitatively analyzed. Our results showed that azosemide and torasemide caused a significant reduction in brain natriuretic peptide (BNP) level. Torasemide also caused a significant decrease in collagen volume fraction (CVF) and edema. No significant difference between the agents concerning glomerular filtration rate (GFR), water extraction, and sodium excretion was demonstrated. Regarding side effects, no significant difference among diuretics was observed in terms of hospital readmission and mortality rates. Diuretics are the main treatment of hypervolemia in HF patients. The choice of appropriate diuretic is essential for successful management and is mainly guided by patient clinical situations and the presence of other co-morbidities.
Collapse
Affiliation(s)
- Peter Samuel Eid
- Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
| | - Doaa Alaa Ibrahim
- Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
| | - Ahmad Helmy Zayan
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Menoufia University, Menoufia, Egypt
| | - Manal Mahmoud Abd Elrahman
- Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan
| | - Mostafa Ahmed Abdo Shehata
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hend Kandil
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mahmoud Ahmed Abouibrahim
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Luc Minh Duy
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Pham Ngoc Thach University of Medicine, Ho Chi Minh, 700000, Vietnam
| | - Ashraf Shinkar
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Psychiatry Department, Ain Shams University, Cairo, Egypt
| | - Muhammed Khaled Elfaituri
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Le Huu Nhat Minh
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Mostafa Mahmoud Fahmy
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dao Ngoc Hien Tam
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Nanogen Pharmaceutical Biotechnology Joint Stock Company, Ho Chi Minh city, 700000, Vietnam
| | - Nguyen Lam Vuong
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Jaffer Shah
- Online research Club (http://www.onlineresearchclub.org/), Nagasaki, Japan.,Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang, 550000, Vietnam.
| |
Collapse
|
11
|
Besche B, Blondel T, Guillot E, Garelli-Paar C, Oyama MA. Efficacy of oral torasemide in dogs with degenerative mitral valve disease and new onset congestive heart failure: The CARPODIEM study. J Vet Intern Med 2020; 34:1746-1758. [PMID: 32767627 PMCID: PMC7517836 DOI: 10.1111/jvim.15864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Torasemide is a potent loop diuretic with potential to treat congestive heart failure (CHF) in dogs. Objective Evaluate the efficacy and safety of torasemide compared to furosemide in dogs with first occurrence of CHF caused by degenerative mitral valve disease (DMVD). Animals Three hundred and nineteen dogs with new onset CHF attributable to DMVD. Methods Double‐blinded randomized noninferiority study of PO torasemide vs furosemide in addition to standard CHF treatment. The primary efficacy criterion was decreased pulmonary edema and cough and no worsening of dyspnea or exercise tolerance at day 14. Secondary endpoints included clinical response at day 84 and time to death, euthanasia, or premature study withdrawal for cardiac reasons. Results Torasemide q24h (n = 161) was noninferior to furosemide q12h (n = 158); percentage of dogs meeting primary efficacy criterion at day 14 was similar between groups (torasemide, 74.4% [95% confidence interval (CI), 66.8%‐81.0%] vs. furosemide, 73.5% [95% CI, 65.7%‐80.4%]; risk ratio [RR], 1.01; 95% CI, 0.89‐1.15; P = .87). Efficacy at day 84 showed similar results (RR, 1.05; 95% CI, 0.88‐1.25; P = .6). Dogs receiving torasemide had a longer time to endpoint and were less than half as likely to experience death, euthanasia, or premature study withdrawal (hazard ratio, 0.36; 95% CI, 0.19‐0.65; P = .001) than dogs receiving furosemide at any time during the study. Conclusion and Clinical importance Torasemide was noninferior to furosemide as first line PO treatment for new onset CHF caused by DMVD. Torasemide significantly decreased risk of cardiac‐related death or premature study withdrawal for cardiac reasons compared to furosemide.
Collapse
Affiliation(s)
| | | | | | | | - Mark A Oyama
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
12
|
Sherif NA, Morra ME, Thanh LV, Elsayed GG, Elkady AH, Elshafay A, Kien ND, Al-Habbaa A, Minh LHN, Y MN, Nghia TLB, Mohammed AT, Eid PS, Turk T, Hirayama K, Huy NT. Torasemide versus furosemide in treatment of heart failure: A systematic review and meta-analysis of randomized controlled trials. J Eval Clin Pract 2020; 26:842-851. [PMID: 31436024 DOI: 10.1111/jep.13261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/27/2019] [Indexed: 12/30/2022]
Abstract
AIM Diuretics are a cornerstone in treatment of heart failure (HF). Torasemide is a loop diuretic with a potential advantage over other diuretics. We aim to meta-analyse and compare the effect of torasemide with furosemide in HF patients. METHODS A comprehensive literature search using 12 databases including PubMed, Scopus, and Web of Science was performed. All randomized controlled trials (RCTs) comparing furosemide and torasemide in HF patients were included and meta-analysed. We assessed the risk of bias using Cochrane Collaboration's tool. The protocol was registered in PROSPERO (CRD42016046112). RESULTS Eighteen RCTs with 1598 patients were included. There was a significant difference between torasemide 20 mg and furosemide 40 mg in increasing the urine volume (standard difference of the mean (SDM) [95% confidence interval] = -0.78 [-1.52 to -0.053], P = .036). Torasemide 10 mg and 10 to 20 mg have a significant effect on potassium excretion in comparison with furosemide 25 to 40 mg (P = .018 and .023, respectively). In general, torasemide and furosemide have no significant difference in mortality, edema improvement, weight loss, heart rate, and reducing systolic/diastolic blood pressure. However, oral torasemide has a significant lower hospital stay P < .001 and superior effect in improving ejection fraction P = .029. CONCLUSION Although not all results are statistically significant, torasemide has potential advantages on multiple aspects of HF management when compared with furosemide. More studies are needed to clarify these effects.
Collapse
Affiliation(s)
- Nourin Ali Sherif
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Online Research Club, Nagasaki, Japan
| | | | - Le Van Thanh
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ghadeer Gamal Elsayed
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Benha University, Benha, Egypt
| | - Aya Hesham Elkady
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Abdelrahman Elshafay
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Nguyen Dang Kien
- Department of Obstetrics and Gynecology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Ahmed Al-Habbaa
- Cardiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Le Huu Nhat Minh
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Mai Nhu Y
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Vo Truong Toan University, Hau Giang, Vietnam
| | - Thai Le Ba Nghia
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Vo Truong Toan University, Hau Giang, Vietnam
| | | | - Peter Samuel Eid
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tarek Turk
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| |
Collapse
|
13
|
Täger T, Fröhlich H, Seiz M, Katus HA, Frankenstein L. READY: relative efficacy of loop diuretics in patients with chronic systolic heart failure-a systematic review and network meta-analysis of randomised trials. Heart Fail Rev 2020; 24:461-472. [PMID: 30874955 DOI: 10.1007/s10741-019-09771-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The majority of patients with chronic heart failure (HF) receive long-term treatment with loop diuretics. The comparative effectiveness of different loop diuretics is unknown. We searched PubMed, clinicaltrials.gov , the Cochrane Central Register of Controlled Trials and the European Union Clinical Trials Register for randomised clinical trials exploring the efficacy of the loop diuretics azosemide, bumetanide, furosemide or torasemide in patients with HF. Comparators included placebo, standard medical care or any other active treatment. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, HF-related hospitalisation and any combined endpoint thereof. Hypokalaemia and acute renal failure were defined as additional safety endpoints. Evidence was synthesised using network meta-analysis (NMA). Thirty-four trials reporting on 2647 patients were included. The overall quality of evidence was rated as moderate. NMA demonstrated no significant differences between loop diuretics with respect to all-cause mortality, cardiovascular mortality or hypokalaemia. In contrast, torasemide ranked best in terms of HF hospitalisation, and there was a trend towards benefits with torasemide with regard to occurrence of acute renal failure. Sensitivity analyses excluding trials with a follow-up < 6 months, trials with a cross-over design and those including < 25 patients confirmed the main results. We found no significant superiority of either loop diuretic with respect to mortality and safety endpoints. However, clinicians may prefer torasemide, as it was associated with fewer HF-related hospitalisations.
Collapse
Affiliation(s)
- Tobias Täger
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hanna Fröhlich
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Mirjam Seiz
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| |
Collapse
|
14
|
Abstract
Decompensated heart failure accounts for approximately 1 million hospitalizations in the United States annually, and this number is expected to increase significantly in the near future. Diuretics provide the initial management in most patients with fluid overload. However, the development of diuretic resistance remains a significant challenge in the treatment of heart failure. Due to the lack of a standard definition, the prevalence of this phenomenon remains difficult to determine, with some estimates suggesting that 25-30% of patients with heart failure have diuretic resistance. Certain characteristics, including low systolic blood pressures, renal impairment, and atherosclerotic disease, help predict the development of diuretic resistance. The underlying pathophysiology is likely multifactorial, with pharmacokinetic alterations, hormonal dysregulation, and the cardiorenal syndrome having significant roles. The therapeutic approach to this common problem typically involves increases in the diuretic dose and/or frequency, sequential nephron blockade, and mechanical fluid movement removal with ultrafiltration or peritoneal dialysis. Paracentesis is potentially useful in patients with intra-abdominal hypertension.
Collapse
|
15
|
Lunney M, Ruospo M, Natale P, Quinn RR, Ronksley PE, Konstantinidis I, Palmer SC, Tonelli M, Strippoli GFM, Ravani P. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev 2020; 2:CD012466. [PMID: 32103487 PMCID: PMC7044419 DOI: 10.1002/14651858.cd012466.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately half of people with heart failure have chronic kidney disease (CKD). Pharmacological interventions for heart failure in people with CKD have the potential to reduce death (any cause) or hospitalisations for decompensated heart failure. However, these interventions are of uncertain benefit and may increase the risk of harm, such as hypotension and electrolyte abnormalities, in those with CKD. OBJECTIVES This review aims to look at the benefits and harms of pharmacological interventions for HF (i.e., antihypertensive agents, inotropes, and agents that may improve the heart performance indirectly) in people with HF and CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies through 12 September 2019 in consultation with an Information Specialist and using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials of any pharmacological intervention for acute or chronic heart failure, among people of any age with chronic kidney disease of at least three months duration. DATA COLLECTION AND ANALYSIS Two authors independently screened the records to identify eligible studies and extracted data on the following dichotomous outcomes: death, hospitalisations, worsening heart failure, worsening kidney function, hyperkalaemia, and hypotension. We used random effects meta-analysis to estimate treatment effects, which we expressed as a risk ratio (RR) with 95% confidence intervals (CI). We assessed the risk of bias using the Cochrane tool. We applied the GRADE methodology to rate the certainty of evidence. MAIN RESULTS One hundred and twelve studies met our selection criteria: 15 were studies of adults with CKD; 16 studies were conducted in the general population but provided subgroup data for people with CKD; and 81 studies included individuals with CKD, however, data for this subgroup were not provided. The risk of bias in all 112 studies was frequently high or unclear. Of the 31 studies (23,762 participants) with data on CKD patients, follow-up ranged from three months to five years, and study size ranged from 16 to 2916 participants. In total, 26 studies (19,612 participants) reported disaggregated and extractable data on at least one outcome of interest for our review and were included in our meta-analyses. In acute heart failure, the effects of adenosine A1-receptor antagonists, dopamine, nesiritide, or serelaxin on death, hospitalisations, worsening heart failure or kidney function, hyperkalaemia, hypotension or quality of life were uncertain due to sparse data or were not reported. In chronic heart failure, the effects of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (4 studies, 5003 participants: RR 0.85, 95% CI 0.70 to 1.02; I2 = 78%; low certainty evidence), aldosterone antagonists (2 studies, 34 participants: RR 0.61 95% CI 0.06 to 6.59; very low certainty evidence), and vasopressin receptor antagonists (RR 1.26, 95% CI 0.55 to 2.89; 2 studies, 1840 participants; low certainty evidence) on death (any cause) were uncertain. Treatment with beta-blockers may reduce the risk of death (any cause) (4 studies, 3136 participants: RR 0.69, 95% CI 0.60 to 0.79; I2 = 0%; moderate certainty evidence). Treatment with ACEi or ARB (2 studies, 1368 participants: RR 0.90, 95% CI 0.43 to 1.90; I2 = 97%; very low certainty evidence) had uncertain effects on hospitalisation for heart failure, as treatment estimates were consistent with either benefit or harm. Treatment with beta-blockers may decrease hospitalisation for heart failure (3 studies, 2287 participants: RR 0.67, 95% CI 0.43 to 1.05; I2 = 87%; low certainty evidence). Aldosterone antagonists may increase the risk of hyperkalaemia compared to placebo or no treatment (3 studies, 826 participants: RR 2.91, 95% CI 2.03 to 4.17; I2 = 0%; low certainty evidence). Renin inhibitors had uncertain risks of hyperkalaemia (2 studies, 142 participants: RR 0.86, 95% CI 0.49 to 1.49; I2 = 0%; very low certainty). We were unable to estimate whether treatment with sinus node inhibitors affects the risk of hyperkalaemia, as there were few studies and meta-analysis was not possible. Hyperkalaemia was not reported for the CKD subgroup in studies investigating other therapies. The effects of ACEi or ARB, or aldosterone antagonists on worsening heart failure or kidney function, hypotension, or quality of life were uncertain due to sparse data or were not reported. Effects of anti-arrhythmic agents, digoxin, phosphodiesterase inhibitors, renin inhibitors, sinus node inhibitors, vasodilators, and vasopressin receptor antagonists were very uncertain due to the paucity of studies. AUTHORS' CONCLUSIONS The effects of pharmacological interventions for heart failure in people with CKD are uncertain and there is insufficient evidence to inform clinical practice. Study data for treatment outcomes in patients with heart failure and CKD are sparse despite the potential impact of kidney impairment on the benefits and harms of treatment. Future research aimed at analysing existing data in general population HF studies to explore the effect in subgroups of patients with CKD, considering stage of disease, may yield valuable insights for the management of people with HF and CKD.
Collapse
Affiliation(s)
- Meaghan Lunney
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
| | - Marinella Ruospo
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | - Patrizia Natale
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | - Robert R Quinn
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
| | - Paul E Ronksley
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
| | - Ioannis Konstantinidis
- University of Pittsburgh Medical CenterDepartment of Medicine3459 Fifth AvenuePittsburghPAUSA15213
| | - Suetonia C Palmer
- Christchurch Hospital, University of OtagoDepartment of Medicine, NephrologistChristchurchNew Zealand
| | - Marcello Tonelli
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
| | - Giovanni FM Strippoli
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - Pietro Ravani
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
| | | |
Collapse
|
16
|
Balsam P, Ozierański K, Marchel M, Gawałko M, Niedziela Ł, Tymińska A, Sieradzki B, Sieradzki M, Fojt A, Bakuła E, Główczyńska R, Peller M, Markulis M, Bednarski J, Kowalik R, Cacko A, Niewiński G, Filipiak KJ, Opolski G, Grabowski M. Comparative effectiveness of torasemide versus furosemide in symptomatic therapy in heart failure patients: Preliminary results from the randomized TORNADO trial. Cardiol J 2020; 26:661-668. [PMID: 31909470 DOI: 10.5603/cj.a2019.0114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/17/2019] [Accepted: 11/23/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Recent reports suggest that torasemide might be more beneficial than furosemide in patients with symptomatic heart failure (HF). The aim was to compare the effects of torasemide and furosemide on clinical outcomes in HF patients. METHODS This study pilot consisted of data from the ongoing multicenter, randomized, unblinded endpoint phase IV TORNADO (NCT01942109) study. HF patients in New York Heart Association (NYHA) II-IV class with a stable dose of furosemide were randomized to treatment with equipotential dose of torasemide (4:1) or continuation of unchanged dose of furosemide. On enrollment and control visit (3 months after enrollment) clinical examination, 6-minute walk test (6MWT) and assessment of fluid retention by ZOE Fluid Status Monitor were performed. The primary endpoint was a composite of improvement of NYHA class, improvement of at least 50 m during 6MWT and decrease in fluid retention of at least 0.5 W after 3-months follow-up. RESULTS The study group included 40 patients (median age 66 years; 77.5% male). During follow-up 7 patients were hospitalized for HF worsening (3 in torasemide and 4 in furosemide-treated patients). The primary endpoint reached 15 (94%) and 14 (58%) patients on torasemide and furosemide, respectively (p = 0.03). CONCLUSIONS In HF patients treated with torasemide fluid overload and symptoms improved more than in the furosemide group. This positive effect occurred already within 3-month observation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Anna Fojt
- I Katedra i Klinika Kardiologii, Poland
| | - Elwira Bakuła
- Cardiology Unit, John Paul II Western Hospital, ul. Daleka 11, 05-825 Grodzisk Mazowiecki, Poland
| | | | | | | | - Janusz Bednarski
- Cardiology Unit, John Paul II Western Hospital, ul. Daleka 11, 05-825 Grodzisk Mazowiecki, Poland
| | | | | | - Grzegorz Niewiński
- Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Banacha 1A, 02-677 Warsaw, Poland
| | | | | | | |
Collapse
|
17
|
Abraham B, Megaly M, Sous M, Fransawyalkomos M, Saad M, Fraser R, Topf J, Goldsmith S, Simegn M, Bart B, Azzo Z, Mesiha N, Sharma R. Meta-Analysis Comparing Torsemide Versus Furosemide in Patients With Heart Failure. Am J Cardiol 2020; 125:92-99. [PMID: 31699358 DOI: 10.1016/j.amjcard.2019.09.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 01/15/2023]
Abstract
Although torsemide's oral bioavailability and half-life theoretically render it a more efficient diuretic than furosemide, the clinical outcomes of torsemide compared with furosemide remain unclear. We performed a systematic review and meta-analysis, including all published studies that compared torsemide and furosemide use in heart failure patients from January 1996 through August 2019. Nineteen studies (9 randomized control trials [RCTs] and 10 observational studies) with a total of 19,280 patients were included. During a mean follow-up duration of 15 months, torsemide was associated with a numerically lower risk of hospitalization due to heart failure (10.6% vs 18.4%; odds ratio [OR] 0.72, 95% confidence interval [CI] [0.51, 1.03], p = 0.07, I2 = 18%; number needed to treat [NNT] = 23) compared with furosemide. Torsemide was associated with statistically significant more improvement in functional status from New York Heart Association (NYHA) class III/IV to I/II (72.5% vs 58%; OR 2.32, 95% CI (1.32, 4.1), p = 0.004, I2 = 27%; NNT = 5) and lower risk of cardiac mortality (1.5% vs 4.4%; OR 0.37, 95% CI (0.20, 0.66), p <0.001, I2 = 0%, NNT = 40) compared with furosemide. However, there was no difference in all-cause mortality or medication side effects between the 2 groups. In conclusion, compared with furosemide, torsemide use was associated with significant more improvement in functional status and lower cardiac mortality; and numerically fewer hospitalizations in patients with heart failure.
Collapse
Affiliation(s)
- Bishoy Abraham
- Department of Medicine, Ascension Saint John Hospital, Detroit, Michigan.
| | - Michael Megaly
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiovascular Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Mina Sous
- Department of Internal Medicine, Amita Health Saint Francis Hospital, Evanston, Illinois
| | - Mina Fransawyalkomos
- Department of Internal Medicine, Saint Joseph University Medical Center, Paterson, New Jersey
| | - Marwan Saad
- Department of Cardiovascular Medicine, University of Arkansas for MedicalSciences, Little Rock, Arkansas; Department of Cardiology, Ain Shams University Hospitals, Cairo, Egypt
| | - Robert Fraser
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiovascular Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Joel Topf
- Division of Nephrology, Department of Medicine, Ascension Saint John Hospital, Detroit, Michigan
| | - Steven Goldsmith
- Division of Cardiovascular Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Mengistu Simegn
- Division of Cardiovascular Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Bradley Bart
- Division of Cardiovascular Medicine, Department of Medicine, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Zain Azzo
- Division of Cardiology, Department of Medicine, Ascension Saint John Hospital, Detroit, Michigan
| | - Nancy Mesiha
- Division of Cardiology, Department of Medicine, Ascension Saint John Hospital, Detroit, Michigan
| | - Rajaninder Sharma
- Department of Medicine, Ascension Saint John Hospital, Detroit, Michigan
| |
Collapse
|
18
|
Abstract
The management of heart failure has changed significantly over the last 30 years, leading to improvements in the quality of life and outcomes, at least for patients with a substantially reduced left ventricular ejection fraction (HFrEF). This has been made possible by the identification of various pathways leading to the development and progression of heart failure, which have been successfully targeted with effective therapies. Meanwhile, many other potential targets of treatment have been identified, and the list is constantly expanding. In this review, we summarise planned and ongoing trials exploring the potential benefit, or harm, of old and new pharmacological interventions that might offer further improvements in treatment for those with HFrEF and extend success to the treatment of patients with heart failure with preserved left ventricular ejection fraction (HFpEF) and other heart failure phenotypes.
Collapse
Affiliation(s)
- Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK.
| | - Muhammad Javed Iqbal Khan
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - Fraser John Graham
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
- National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| |
Collapse
|
19
|
Potter BM, Ames MK, Hess A, Poglitsch M. Comparison between the effects of torsemide and furosemide on the renin-angiotensin-aldosterone system of normal dogs. J Vet Cardiol 2019; 26:51-62. [PMID: 31809955 DOI: 10.1016/j.jvc.2019.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION/OBJECTIVES We hypothesized that torsemide and furosemide, at approximately equipotent dosages (similar diuresis), would have comparable effects on the circulating renin-angiotensin-aldosterone system. ANIMALS, MATERIALS AND METHODS Six, healthy, middle-aged, male Beagles were randomized to receive torsemide (0.1 mg/kg PO q 12 h), furosemide (2.0 mg/kg PO q 12 h), or placebo for 10 days during three separate periods, separated by a 10-day washout period, in a crossover design. Blood was collected on days 1, 5, and 9 and 24-h urine collection ended on days 2, 6, and 10. After repeated measures analysis and Bonferonni correction, variables with an adjusted p<0.05 were investigated further, using Tukey's method. RESULTS Twenty-four-hour urine production differed significantly between the diuretics only on day 10, with torsemide causing a 38% greater diuresis than furosemide. There was, however, no significant difference in average 3-day diuresis. There were no significant differences between diuretics in the 24-h urinary excretion of sodium, chloride, or potassium, though furosemide caused less kaliuresis than torsemide. Serum renin, angiotensin II, and aldosterone and the urine aldosterone-to-creatinine ratio were significantly increased in the diuretic groups, as compared to placebo on days 5/6 and 9/10. There were no significant differences in these values between diuretics. Creatinine and blood urea nitrogen concentrations rose comparably in the diuretic groups, remaining within reference intervals in all dogs. CONCLUSIONS At approximately equipotent dosages (20:1), torsemide and furosemide produced comparable renin-angiotensin-aldosterone system activation. Torsemide's similar potassium excretion profile to furosemide decreases support for a hypothesized mineralocorticoid-receptor blocking capability.
Collapse
Affiliation(s)
- B M Potter
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO, 80523, USA
| | - M K Ames
- Department of Clinical Sciences, Colorado State University, Campus Delivery 1678, Fort Collins, CO, 80523, USA.
| | - A Hess
- Department of Statistics, Colorado State University, 102 Statistics Building, Fort Collins, CO, 80523, USA
| | - M Poglitsch
- Attoquant Diagnostics GmbH, Campus Vienna Biocenter 5, 1030 Vienna Austria
| |
Collapse
|
20
|
Sharma A, Kuppachi S, Subramani S, Walia A, Thomas J, Ramakrishna H. Loop Diuretics-Analysis of Efficacy Data for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2019; 34:2253-2259. [PMID: 31879151 DOI: 10.1053/j.jvca.2019.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/20/2019] [Indexed: 11/11/2022]
Abstract
HEART FAILURE (HF) is one of the most common causes of hospitalization in the United States. Loop diuretics (LD) are the mainstay of treatment in the management of acute and chronic HF. Although they generally are effective in relieving symptoms and reducing congestion, LD have not been shown to significantly affect morbidity and mortality. The initial decongestion strategy for management of HF is likely to be an LD, with evidence suggesting that an initial "high-dose" strategy either by twice-daily bolus injection or by continuous infusion is likely to be more successful than an initial lower dose in respect to relief of symptoms but at the expense of increased worsening of renal function. This review focuses on the current state of evidence of different strategies related to the use of LD in the treatment of congestive symptoms in critically ill patients and presents a summary of the body of evidence regarding dosages, timing, and different diuretic agents.
Collapse
Affiliation(s)
- Archit Sharma
- Division of Cardiothoracic Anesthesiology Solid Organ Transplant and Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sarat Kuppachi
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Sudhakar Subramani
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Anureet Walia
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Jacob Thomas
- Department of Anesthesia, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
21
|
Ozierański K, Balsam P, Kapłon-Cieślicka A, Tymińska A, Kowalik R, Grabowski M, Peller M, Wancerz A, Marchel M, Crespo-Leiro MG, Maggioni AP, Drożdż J, Filipiak KJ, Opolski G. Comparative Analysis of Long-Term Outcomes of Torasemide and Furosemide in Heart Failure Patients in Heart Failure Registries of the European Society of Cardiology. Cardiovasc Drugs Ther 2019; 33:77-86. [PMID: 30649675 DOI: 10.1007/s10557-018-6843-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Current clinical recommendations do not emphasise superiority of any of diuretics, but available reports are very encouraging and suggest beneficial effects of torasemide. This study aimed to compare the effect of torasemide and furosemide on long-term outcomes and New York Heart Association (NYHA) class change in patients with chronic heart failure (HF). METHODS Of 2019 patients enrolled in Polish parts of the heart failure registries of the European Society of Cardiology (Pilot and Long-Term), 1440 patients treated with a loop diuretic were included in the analysis. The main analysis was performed on matched cohorts of HF patients treated with furosemide and torasemide using propensity score matching. RESULTS Torasemide was associated with a similar primary endpoint (all-cause death; 9.8% vs. 14.1%; p = 0.13) occurrence and 23.8% risk reduction of the secondary endpoint (a composite of all-cause death or hospitalisation for worsening HF; 26.4% vs. 34.7%; p = 0.04). Treatment with both torasemide and furosemide was associated with the significantly most frequent occurrence of the primary (23.8%) and secondary (59.2%) endpoints. In the matched cohort after 12 months, NYHA class was higher in the furosemide group (p = 0.04), while furosemide use was associated with a higher risk (20.0% vs. 12.9%; p = 0.03) of worsening ≥ 1 NYHA class. Torasemide use impacted positively upon the primary endpoint occurrence, especially in younger patients (aged < 65 years) and with dilated cardiomyopathy. CONCLUSIONS Our findings contribute to the body of research on the optimal diuretic choice. Torasemide may have advantageous influence on NYHA class and long-term outcomes of HF patients, especially younger patients or those with dilated cardiomyopathy, but it needs further investigations in prospective randomised trials.
Collapse
Affiliation(s)
- Krzysztof Ozierański
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| | - Paweł Balsam
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland.
| | - Agnieszka Kapłon-Cieślicka
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| | - Agata Tymińska
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| | - Robert Kowalik
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| | - Marcin Grabowski
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| | - Michał Peller
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| | - Anna Wancerz
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| | - Michał Marchel
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| | - Maria G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario A Coruna, CIBERCV, La Coruna, Spain
| | - Aldo P Maggioni
- ANMCO Research Centre, Florence, Italy.,EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France
| | - Jarosław Drożdż
- Department of Cardiology, Cardiology and Cardiac Surgery, Medical University of Lodz, Lodz, Poland
| | - Krzysztof J Filipiak
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| | - Grzegorz Opolski
- Department of Cardiology, Public Central Teaching Hospital in Warsaw, Medical University of Warsaw, 1a Banacha St., 02-097, Warsaw, Poland
| |
Collapse
|
22
|
Miles JA, Hanumanthu BK, Patel K, Chen M, Siegel RM, Kokkinidis DG. Torsemide versus furosemide and intermediate-term outcomes in patients with heart failure. J Cardiovasc Med (Hagerstown) 2019; 20:379-388. [DOI: 10.2459/jcm.0000000000000794] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
23
|
House AA, Wanner C, Sarnak MJ, Piña IL, McIntyre CW, Komenda P, Kasiske BL, Deswal A, deFilippi CR, Cleland JGF, Anker SD, Herzog CA, Cheung M, Wheeler DC, Winkelmayer WC, McCullough PA. Heart failure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int 2019; 95:1304-1317. [PMID: 31053387 DOI: 10.1016/j.kint.2019.02.022] [Citation(s) in RCA: 207] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 12/24/2022]
Abstract
The incidence and prevalence of heart failure (HF) and chronic kidney disease (CKD) are increasing, and as such a better understanding of the interface between both conditions is imperative for developing optimal strategies for their detection, prevention, diagnosis, and management. To this end, Kidney Disease: Improving Global Outcomes (KDIGO) convened an international, multidisciplinary Controversies Conference titled Heart Failure in CKD. Breakout group discussions included (i) HF with preserved ejection fraction (HFpEF) and nondialysis CKD, (ii) HF with reduced ejection fraction (HFrEF) and nondialysis CKD, (iii) HFpEF and dialysis-dependent CKD, (iv) HFrEF and dialysis-dependent CKD, and (v) HF in kidney transplant patients. The questions that formed the basis of discussions are available on the KDIGO website http://kdigo.org/conferences/heart-failure-in-ckd/, and the deliberations from the conference are summarized here.
Collapse
Affiliation(s)
- Andrew A House
- Division of Nephrology, Department of Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada.
| | - Christoph Wanner
- Department of Medicine, Division of Nephrology, University Hospital of Würzburg, Würzburg, Germany
| | - Mark J Sarnak
- Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Ileana L Piña
- Division of Cardiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Christopher W McIntyre
- Division of Nephrology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Paul Komenda
- Department of Internal Medicine, Section of Nephrology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Medicine, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, Seven Oaks General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Anita Deswal
- Section of Cardiology, Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, USA; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Stefan D Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité - Universitätsmedizin Berlin, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK, German Centre for Cardiovascular Research), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Charles A Herzog
- Division of Cardiology, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota, USA; Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA
| | | | | | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Peter A McCullough
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, Texas, USA; Department of Internal Medicine, Division of Cardiology, Baylor Heart and Vascular Institute, Dallas, Texas, USA.
| | | |
Collapse
|
24
|
Affiliation(s)
- David H Ellison
- Departments of Medicine and Physiology and Pharmacology, Oregon Health & Science University, Portland, Oregon; and Renal Section, Veterans Affairs Portland Health Care System, Portland, Oregon
| |
Collapse
|
25
|
Suzuki S, Motoki H, Kanzaki Y, Maruyama T, Hashizume N, Kozuka A, Yahikozawa K, Kuwahara K. Comparison of Long-Acting and Short-Acting Loop Diuretics in the Treatment of Heart Failure With Preserved Ejection Fraction. Circ Rep 2019; 1:137-141. [PMID: 33693128 PMCID: PMC7890284 DOI: 10.1253/circrep.cr-19-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background:
Clinical evidence of the effects of loop diuretics in patients with heart failure with preserved ejection fraction (HFpEF) is lacking. Thus, we compared the impact of azosemide and furosemide, long- and short-acting loop diuretics, in patients with HFpEF. Methods and Results:
A prospective multicenter cohort study was conducted between July 2014 and July 2018. We enrolled 301 consecutive patients with HFpEF (median age, 84 years; IQR, 79–88 years; 54.8% female). Azosemide was used in 127 patients (azosemide group), and furosemide in 174 (furosemide group). We constructed Cox models for a composite of cardiac death, non-fatal myocardial infarction, non-fatal stroke, and HF hospitalization (primary endpoints). During a median follow-up of 317 days (IQR, 174–734 days), the primary endpoint occurred in 112 patients (37.2%). On multivariate inverse probability of treatment weighted (IPTW) Cox modeling, the azosemide group had a significantly lower incidence of adverse events than the furosemide group (hazard ratio [HR], 0.46; 95% confidence interval [CI]: 0.27–0.80; P=0.006). Furthermore, on multivariate IPTW Cox modeling for the secondary endpoints, cardiac death (HR, 0.38; 95% CI: 0.17–0.89; P=0.025) and unplanned hospitalization for decompensated HF (HR, 0.50; 95% CI: 0.28–0.89; P=0.018) were also reduced in the azosemide group. Conclusions:
Azosemide significantly reduced the risk of adverse events compared with furosemide in HFpEF patients.
Collapse
Affiliation(s)
- Sho Suzuki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Takuya Maruyama
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Naoto Hashizume
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Ayako Kozuka
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Kumiko Yahikozawa
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| |
Collapse
|
26
|
Kido K, Shimizu M, Hashiguchi M. Comparing torsemide versus furosemide in patients with heart failure: A meta-analysis. J Am Pharm Assoc (2003) 2019; 59:432-438. [PMID: 30846351 DOI: 10.1016/j.japh.2019.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of torsemide versus furosemide in patients with heart failure (HF). DATA SOURCES Medline, Cochrane Library, Web of Science, and Google Scholar database searches for relevant articles from 1946 to May 2018 were performed with the use of the key words torsemide and furosemide. STUDY SELECTION Studies were included if they met the following criteria: (1) cohort studies or randomized controlled trials of adult patients 18 years of age or older who received oral torsemide or furosemide for HF with reduced or preserved ejection fraction; and (2) studies that reported mortality rate, rehospitalization rate for HF or cardiovascular disease (CVD), or New York Heart Association (NYHA) functional class changes. DATA EXTRACTION Efficacy outcomes were mortality from any cause, rehospitalization for HF, rehospitalization for CVD, and NYHA functional class improvement. Safety outcome included hypokalemia. RESULTS In the 5 included studies, there was no significant difference in mortality between torsemide and furosemide (odds ratio [OR] 1.00, 95% CI 0.58-1.72; P = 0.99; I2 = 79%). There was no significant difference in rehospitalization rates for HF (OR 0.79, 95% CI 0.57-1.09; P = 0.15; I2 = 64%) or CVD (OR 0.83, 95% CI 0.62-1.12; P = 0.22; I2 = 40%) between torsemide- and furosemide-treated patients. The use of torsemide was associated with significant improvement in NYHA functional class compared with furosemide (OR 1.44, 95% CI 1.18-1.76; P = 0.0004; I2 = 0%). CONCLUSION Our meta-analysis showed that torsemide is associated with statistically significant improvement in NYHA functional class for patients with HF compared with furosemide. However, torsemide did not provide significant benefits in reducing mortality or rehospitalization rates for HF or CVD compared with furosemide. The authors suggest switching from furosemide to torsemide in patients with HF not achieving symptomatic control with the use of furosemide despite maximizing guideline-directed medical therapy and furosemide dosing.
Collapse
|
27
|
Affiliation(s)
- Steven D Anisman
- SVMC Cardiology, Dartmouth Hitchcock Department of Cardiovascular Medicine, Bennington, VT, USA
| | - Stephen B Erickson
- Mayo Clinic, Division of Nephrology and Hypertension, Rochester, MN, USA
| | - Nancy E Morden
- The Dartmouth Institute for Health Policy & Clinical Practice, The Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| |
Collapse
|
28
|
Täger T, Fröhlich H, Grundtvig M, Seiz M, Schellberg D, Goode K, Kazmi S, Hole T, Katus HA, Atar D, Cleland JGF, Agewall S, Clark AL, Frankenstein L. Comparative effectiveness of loop diuretics on mortality in the treatment of patients with chronic heart failure - A multicenter propensity score matched analysis. Int J Cardiol 2019; 289:83-90. [PMID: 30827731 DOI: 10.1016/j.ijcard.2019.01.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/04/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Loop diuretics are given to the majority of patients with chronic heart failure (HF). Whether the different pharmacological properties of the three guideline-recommended loop diuretics result in differential effects on survival is unknown. METHODS 6293 patients with chronic HF using either bumetanide, furosemide or torasemide were identified in three European HF registries. Patients were individually matched on both the respective propensity scores for receipt of the individual drug and dose-equivalents thereof. RESULTS During a follow-up of 35,038 patient-years, 652 (53.7%), 2179 (51.9%), and 268 (30.4%) patients died amongst those prescribed bumetanide, furosemide, and torasemide, respectively. In univariable analyses of the general sample, bumetanide and furosemide were both associated with higher mortality as compared with torasemide treatment (HR 1.50, 95% CI 1.31-1.73, p < 0.001, and HR 1.34, CI 1.18-1.52, p < 0.001, respectively). Mortality was higher in bumetanide users when compared to furosemide users (HR 1.11, 95% CI 1.02-1.20, p = 0.01). However, there was no significant association between loop diuretic choice and all-cause mortality in any of the matched samples (bumetanide vs. furosemide, HR 1.03, 95% CI 0.93-1.14, p = 0.53; bumetanide vs. torasemide, HR 0.98, 95% CI 0.78-1.24, p = 0.89; furosemide vs. torasemide, HR 1.02, 95% CI 0.84-1.24, p = 0.82). The results were confirmed in subgroup analyses with respect to age, sex, left ventricular ejection fraction, NYHA functional class, cause of HF, rhythm, and systolic blood pressure. CONCLUSIONS In patients with HF, mortality is not affected by the choice of individual loop diuretics.
Collapse
Affiliation(s)
- Tobias Täger
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology, Heidelberg, Germany
| | - Hanna Fröhlich
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology, Heidelberg, Germany
| | - Morten Grundtvig
- Medical Department, Innlandet Hospital Trust Division Lillehammer, Lillehammer, Norway
| | - Mirjam Seiz
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology, Heidelberg, Germany
| | - Dieter Schellberg
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology, Heidelberg, Germany
| | - Kevin Goode
- Hull York Medical School at Castle Hill Hospital, Hull, United Kingdom
| | - Syed Kazmi
- Hull York Medical School at Castle Hill Hospital, Hull, United Kingdom
| | - Torstein Hole
- Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Norway & Medical Clinic, Helse Møre and Romsdal HF, Ålesund, Norway
| | - Hugo A Katus
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology, Heidelberg, Germany
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - John G F Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, United Kingdom; Robertson Centre for Biostatistics & Clinical Trials, Glasgow, United Kingdom
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Andrew L Clark
- Hull York Medical School at Castle Hill Hospital, Hull, United Kingdom
| | - Lutz Frankenstein
- University Hospital Heidelberg, Department of Cardiology, Angiology and Pulmology, Heidelberg, Germany.
| |
Collapse
|
29
|
Practical management of concomitant acute heart failure and worsening renal function in the emergency department. Eur J Emerg Med 2018; 25:229-236. [PMID: 28984663 DOI: 10.1097/mej.0000000000000505] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Worsening renal function (i.e. any increase in creatinine or decrease in the estimated glomerular filtration rate) is common in patients admitted for acute heart failure in the emergency department. Although worsening renal function (WRF) has been associated with the occurrence of dismal outcomes, this only appears to be the case when associated with clinical deterioration. However, if the clinical status of the patient is improving, a certain increase in serum creatinine may be acceptable. This WRF, which is not associated with clinical deterioration or adverse outcomes (e.g. during treatment up-titration), has been referred to as 'pseudo-WRF' and should not detract clinicians from targeting 'guideline-recommended' therapies. This is an important message for emergency physicians to pursue diuretics as long as signs of pulmonary congestion persist to improve the clinical status of the patient. In the present review, we aim to provide clinicians in acute settings with an integrative and comprehensive approach to cardiorenal interactions in acute heart failure.
Collapse
|
30
|
Shah P, Patel H, Mithawala P, Doshi R. Torsemide versus furosemide in heart failure patients: A meta-analysis of randomized controlled trials. Eur J Intern Med 2018; 57:e38-e40. [PMID: 30177487 DOI: 10.1016/j.ejim.2018.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 08/27/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Priyank Shah
- Department of Internal Medicine, Medical College of Georgia-Southwest Clinical Campus, Albany, Georgia; Department of Cardiology, Phoebe Putney Memorial Hospital, Albany, Georgia.
| | - Hiten Patel
- Department of Cardiology, New York Medical College at St. Joseph's Regional Medical Center, Paterson, NJ, United States
| | - Priyam Mithawala
- Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, SC, United States
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, United States
| |
Collapse
|
31
|
Yao Y, Zhang J, Zhang Y, Zhang R. Can Torsemide and Combination of Loop Diuretics Improve Mortality in Patients with Chronic Heart Failure After Discharge? Int Heart J 2018; 59:813-820. [DOI: 10.1536/ihj.17-522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Younan Yao
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center of Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jian Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center of Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yuhui Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center of Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Rongcheng Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center of Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| |
Collapse
|
32
|
Verma AK, Sun JL, Hernandez A, Teerlink JR, Schulte PJ, Ezekowitz J, Voors A, Starling R, Armstrong P, O'Conner CM, Mentz RJ. Rate pressure product and the components of heart rate and systolic blood pressure in hospitalized heart failure patients with preserved ejection fraction: Insights from ASCEND-HF. Clin Cardiol 2018; 41:945-952. [PMID: 29781109 DOI: 10.1002/clc.22981] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Heart rate and systolic blood pressure (SBP) are prognostic markers in heart failure (HF) with reduced ejection fraction (HFrEF). Their combination in rate pressure product (RPP) as well as their role in heart failure with preserved ejection fraction (HFpEF) remains unclear. HYPOTHESIS RPP and its components are associated with HFpEF outcomes. METHODS We performed an analysis of Acute Study of Clinical Effectiveness of Nesiritide in Subjects With Decompensated Heart Failure (ASCEND-HF; http://www.clinicaltrials.gov NCT00475852), which studied 7141 patients with acute HF. HFpEF was defined as left ventricular ejection fraction ≥40%. Outcomes were assessed by baseline heart rate, SBP, and RPP, as well as the change of these variables using adjusted Cox models. RESULTS After multivariable adjustment, in-hospital change but not baseline heart rate, SBP, and RPP were associated with 30-day mortality/HF hospitalization (hazard ratio [HR]: 1.17 per 5-bpm heart rate, HR: 1.20 per 10-mm Hg SBP, and HR: 1.02 per 100 bpm × mm Hg RPP; all P < 0.05). Baseline SBP was associated with 180-day mortality (HR: 0.88 per 10-mm Hg, P = 0.028). Though change in RPP was associated with 30-day mortality/HF hospitalization, the RPP baseline variable did not provide additional associative information with regard to outcomes when compared with assessment of baseline heart rate and SBP variables alone. CONCLUSIONS An increase in heart rate and SBP from baseline to discharge was associated with increased 30-day mortality/HF hospitalization in HFpEF patients with acute exacerbation. These findings suggest value in monitoring the trend of vital signs during HFpEF hospitalization.
Collapse
Affiliation(s)
- Amanda K Verma
- Department of Cardiology, Washington University School of Medicine, St. Louis, Missouri
| | - Jie-Lena Sun
- Department of Statistics, Duke University Medical Center, Durham, North Carolina
| | - Adrian Hernandez
- Department of Cardiology, Duke Clinical Research Institute, Duke Hospital, Durham, North Carolina
| | - John R Teerlink
- Department of Cardiology, School of Medicine, University of California, San Francisco
| | - Phillip J Schulte
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Adriaan Voors
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Paul Armstrong
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Christopher M O'Conner
- Department of Cardiology, Duke Clinical Research Institute, Duke Hospital, Durham, North Carolina
| | - Robert J Mentz
- Department of Cardiology, Duke Clinical Research Institute, Duke Hospital, Durham, North Carolina
| |
Collapse
|
33
|
|
34
|
Carubelli V, Metra M, Lund LH. Negotiating renal dysfunction when treating patients with heart failure. Expert Rev Cardiovasc Ther 2018; 16:113-122. [PMID: 29292652 DOI: 10.1080/14779072.2018.1422178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is one of the most prevalent comorbidities in HF, and no specific treatment is still available for the so-called cardiorenal syndrome. Areas covered: The aim of this review is to describe the interaction of heart and kidney function and the consequences of cardiorenal syndrome, focusing on the use of available therapeutics. Expert commentary: The presence of CKD has been associated with adverse outcomes in HF regardless of ejection fraction. On the other hand, cardiovascular events are the most common causes of morbidity and mortality among CKD patients, reflecting the close pathophysiological crosstalk between these organs. Multiple mechanisms are involved in the development of cardiorenal syndrome, including hemodynamic, neurohormonal and inflammatory mediators. The management of several HF drugs is a challenge in the presence of CKD mainly due to blunted diuretic response and increased risk of worsening of kidney function. Therefore, finding a balance between the optimization of cardiac and renal outcomes is a real negotiation in the everyday clinical practice.
Collapse
Affiliation(s)
- Valentina Carubelli
- a Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health , University and Civil Hospital of Brescia , Brescia , Italy
| | - Marco Metra
- a Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health , University and Civil Hospital of Brescia , Brescia , Italy
| | - Lars H Lund
- b Unit of Cardiology, Department of Medicine , Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital , Solna , Sweden
| |
Collapse
|
35
|
Therapeutic Advances in Hyponatremia: Fluids, Diuretics, Vaptans, and More. Am J Ther 2018. [DOI: 10.1097/mjt.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Kurlykina NV, Seredenina EM, Orlova YA. [Use of loop diuretics in heart failure: Current aspects]. TERAPEVT ARKH 2017; 89:115-119. [PMID: 29039840 DOI: 10.17116/terarkh2017899115-119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Loop diuretics take the lead in the treatment of patients with symptomatic heart failure. Torasemide is the most effective and safe loop diuretic with the optimal pharmacokinetic profile, the additional properties associated with simultaneous blockade of the renin-angiotensin-aldosterone system and with the antiadrenergic effects of the drug, its positive impact on myocardial fibrosis and minimal severe potential negative effects. Sustained-release torasemide provides a more comfortable removal of excess liquid and does not deteriorate quality of life.
Collapse
Affiliation(s)
- N V Kurlykina
- Medical Education Research Center, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - E M Seredenina
- Medical Education Research Center, M.V. Lomonosov Moscow State University, Moscow, Russia
| | - Yа A Orlova
- Medical Education Research Center, M.V. Lomonosov Moscow State University, Moscow, Russia
| |
Collapse
|
37
|
Yandrapalli S, Tariq S, Aronow WS. Advances in chemical pharmacotherapy for managing acute decompensated heart failure. Expert Opin Pharmacother 2017; 18:471-485. [PMID: 28276970 DOI: 10.1080/14656566.2017.1299708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Acute decompensated heart failure (ADHF) contributes largely to the burden of heart failure and is associated with a poorer prognosis. Although numerous clinical trials evaluated the benefit of newer medications for ADHF, most of them were not successful. Areas covered: This review focusses on the updates on recent developments in chemical pharmacotherapy for the management of ADHF. A MEDLINE search for relevant review articles and original investigations on newer drugs for ADHF provided us with necessary literature. Expert opinion: Currently, popular therapies like diuretics, vasodilators, and inotropes offer symptomatic relief but do not provide survival benefit. Although multiple medications targeting novel pathways in ADHF were studied extensively, they failed to show either symptomatic or mortality benefit in available randomized trials. Improving our understanding of the complex pathophysiology of ADHF along with designing studies which include patients who are more representative of the real-world heart failure population, standardizing methods for endpoint assessment, and evaluating the role on novel biomarkers of organ dysfunction is important to improve ADHF research. Enhancing preventive strategies like improving baseline therapy in chronic heart failure patients and developing strategies for early identification of ADHF are important as our quest for innovative ADHF pharmacotherapy continues.
Collapse
Affiliation(s)
- Srikanth Yandrapalli
- a Cardiology Division, Department of Medicine , Westchester Medical Center and New York Medical College , Valhalla , NY , USA
| | - Sohaib Tariq
- a Cardiology Division, Department of Medicine , Westchester Medical Center and New York Medical College , Valhalla , NY , USA
| | - Wilbert S Aronow
- a Cardiology Division, Department of Medicine , Westchester Medical Center and New York Medical College , Valhalla , NY , USA
| |
Collapse
|
38
|
Springer J, Anker SD. Publication trends in cachexia and sarcopenia in elderly heart failure patients. Wien Klin Wochenschr 2016; 128:446-454. [PMID: 27885423 DOI: 10.1007/s00508-016-1126-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/26/2016] [Indexed: 12/11/2022]
Abstract
The loss of skeletal mass - sarcopenia and cachexia - is considered to be a major contributor to morbidity and mortality in chronic heart failure (CHF). Unfortunately, sarcopenia is generally considered to be a geriatric syndrome, but not necessarily seen as a comorbidity in CHF, even though it has a wide range of adverse health outcomes. While there were 15,574 publication with the title word "heart failure" in PubMed in the 5‑year period from 1 June 2011 to 31 May 2016, only 22 or 71 publications were found with the search combination "sarcopenia" or "cachexia" (title word) and "heart failure" (all fields), respectively. This shows very clearly that loss of muscle quality and function due to heart failure is still an underappreciated problem in the medical field.
Collapse
Affiliation(s)
- Jochen Springer
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Stefan D Anker
- Institute of Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| |
Collapse
|
39
|
|