Evidence map›Paper›PMID 38745502›Full record

Trial reportEuropean journal of heart failure2024

On-treatment analysis of torsemide versus furosemide for patients hospitalized for heart failure: A post-hoc analysis of TRANSFORM-HF.

Veraprapas Kittipibul, Robert J Mentz, Robert M Clare, Daniel M Wojdyla, Kevin J Anstrom, Eric L Eisenstein, Andrew P Ambrosy, Parag Goyal, Hal A Skopicki, Fassil Ketema and 5 more

Registry-linked trialAbstract readMulticenter StudyPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in European journal of heart failure, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03296813 (TRANSFORM-HF), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03296813 phase3completednot on this map

TRANSFORM-HF: ToRsemide compArisoN With furoSemide FORManagement of Heart Failure

TypeinterventionalSponsorDuke UniversityRan2018 to 2022Enrolled2,973ConditionsHeart FailureArmsTorsemide, Furosemide
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Diuretic Use in Heart Failure.Reviews in cardiovascular medicine · 2025
    Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Veraprapas KittipibulDuke Clinical Research Institute, Durham, NC, USA.
Robert J MentzDuke Clinical Research Institute, Durham, NC, USA.
Robert M ClareDuke Clinical Research Institute, Durham, NC, USA.
Daniel M WojdylaDuke Clinical Research Institute, Durham, NC, USA.
Kevin J AnstromGillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
Eric L EisensteinDuke Clinical Research Institute, Durham, NC, USA.
Andrew P AmbrosyDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Parag GoyalDepartment of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA.
Hal A SkopickiDivision of Cardiology, Stony Brook University, Stony Brook, NY, USA.
Fassil KetemaDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
Dong-Yun KimDivision of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
Patrice Desvigne-NickensDivision of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
Bertram PittDivision of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
Eric J VelazquezSection of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Stephen J GreeneDuke Clinical Research Institute, Durham, NC, USA.

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
TRANSFORM-HF CCCU01HL125511 · NHLBI · YALE UNIVERSITY · PI MENTZ, ROBERT JOHN, VELAZQUEZ, ERIC J · 2017 to 2021
$7.7M
TRANSFORM-HF DCCU01HL125478 · NHLBI · DUKE UNIVERSITY · PI CHAKRABORTY, HRISHIKESH · 2017 to 2021
$3.7M
Cardio-Renal Effects of Torsemide vs. Furosemide: A TRANSFORM-HF Mechanistic Sub-StudyR01HL148354 · NHLBI · YALE UNIVERSITY · PI TESTANI, JEFFREY M · 2019 to 2022
$3.3M
The optimal loop diuretic: mechanistic insights from longitudinal changes in blood and urine proteins to explain efficacy and safety of torsemide vs furosemide after a heart failure hospitalizationR01HL154768 · NHLBI · INOVA HEALTH CARE SERVICES · PI COOPER, LAUREN BETH, DEFILIPPI, CHRISTOPHER R · 2020 to 2023
$1.6M
NCATS NIH HHS UL1 TR001863NHLBI NIH HHS R01 HL148354NHLBI NIH HHS R01HL148354-04NHLBI NIH HHS R01 HL154768NHLBI NIH HHS R01HL154768-02NHLBI NIH HHS U01 HL125478NHLBI NIH HHS U01-HL125478NHLBI NIH HHS U01 HL125511NHLBI NIH HHS U01-HL125511
6 · The paper itself

Abstract

aimThe TRANSFORM-HF trial demonstrated no significant outcome differences between torsemide and furosemide following hospitalization for heart failure (HF), but may have been impacted by non-adherence to the randomized diuretic. The current study sought to determine the treatment effect of torsemide versus furosemide using an on-treatment analysis inclusive of all randomized patients except those confirmed non-adherent to study diuretic. METHODS AND

resultsTRANSFORM-HF was an open-label, pragmatic randomized trial of 2859 patients hospitalized for HF from June 2018 through March 2022. Patients were randomized to a loop diuretic strategy of torsemide versus furosemide with investigator-selected dosage. This post-hoc on-treatment analysis included all patients alive with either known or unknown diuretic status, and excluded patients confirmed to be non-adherent to study diuretic. This modified on-treatment definition was applied separately at time of hospital discharge and 30-day follow-up. All-cause mortality and hospitalization outcomes were assessed over 12 months. Overall, 2570 (89.9%) and 2374 (83.0%) patients were included in on-treatment analyses at discharge and 30-day follow-up, respectively. There was no significant difference in all-cause mortality between torsemide and furosemide in patients on-treatment at discharge (17.5% vs. 17.8%; hazard ratio [HR] 1.01 [95% confidence interval [CI] 0.83-1.22], p = 0.96) and at 30-day follow-up (14.5% vs. 15.0%; HR 1.02 [95% CI 0.81-1.27], p = 0.90). All-cause mortality or all-cause hospitalization was similar between torsemide and furosemide in patients who were on-treatment at discharge (58.3% vs. 61.3%; HR 0.92 [95% CI 0.82-1.03]) and 30-day follow-up (60.9% vs. 64.4%; HR 0.93 [95% CI 0.82-1.05]). In patients who were on-treatment at 30-day follow-up, there were 677 total hospitalizations in the torsemide group and 686 total hospitalizations in the furosemide group (rate ratio 0.99 [95% CI 0.86-1.14], p = 0.87).

conclusionsIn TRANSFORM-HF, a post-hoc on-treatment analysis did not meaningfully differ from the original trial results. Among those deemed compliant with the assigned diuretic, there remained no significant difference in mortality or hospitalization after HF hospitalization with a strategy of torsemide versus furosemide. CLINICAL TRAIL REGISTRATION: ClinicalTrials.gov Identifier: NCT03296813.

Indexed as

FurosemideHeart FailureHospitalizationSodium Potassium Chloride Symporter InhibitorsTorsemideAgedDiureticsFemaleHumansMaleMiddle AgedTreatment OutcomeDiureticsFurosemideSodium Potassium Chloride Symporter InhibitorsTorsemideClinical trialDiureticHeart failureOn‐treatment

Identifiers

PMID38745502
PMCPMC11269016

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.