Abstract 4139032: Torsemide versus furosemide for hospitalization in patients with heart failure: a meta-analysis and trial sequential analysis

Background: Furosemide is the most commonly used loop diuretic in patients with heart failure (HF). However, recent studies suggest that torsemide might be a better option, potentially reducing hospitalization rates. This meta-analysis aimed to compare the effectiveness of torsemide versus furosemide in patients with HF. Methods: We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing torsemide versus furosemide in HF patients. We pooled risk ratios (RR) for binary outcomes, and mean differences (MD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We performed a trial sequential analysis (TSA) to assess the random risk of HF-related hospitalizations. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses. Results: Our meta-analysis included 9 RCTs comprising 4077 patients, of whom 2014 (49.4%) were randomized to torsemide. The mean age was 65.9 years old. Torsemide significant reduced the HF-related hospitalizations (RR 0.61; 95% CI: 0.45 to 0.83; p<0.05; Figure A), cardiovascular hospitalization (RR 0.73; 95% CI: 0.61 to 0.89; p<0.05; Figure B), and all-cause hospitalization (RR 0.95; 95% CI: 0.90 to 0.99; p<0.05; Figure C). However, there were no significant differences in all-cause mortality (RR 0.98; 95% CI: 0.88 to 1.11; Figure D) between groups. Additionally, for the primary endpoint, TSA suggested a low risk of type 1 error; therefore, this result may be conclusive (Figure E). Conclusion: In patients with heart failure, torsemide significantly reduced the incidence of hospitalizations. However, it appears not to have significant benefits in mortality rates.