American heart journal
July 8, 2026 · via Europe PMC
Comparative effectiveness of torsemide vs furosemide in the management of heart failure patients: Win-ratio reanalysis of the TRANSFORM-HF trial.
Tong G, Zeng Y, Greene SJ, Anstrom KJ, Testani J, Mentz RJ, Li F, Velazquez EJ.
AI summary — for doctors, generated from the abstract only
A win-ratio reanalysis of the TRANSFORM-HF trial, which combined mortality, hospitalizations, and patient-reported health status into a single hierarchical outcome, confirmed no significant difference between torsemide and furosemide for managing heart failure congestion.
What was studied
A secondary win-ratio analysis of the TRANSFORM-HF trial, which randomized 2,859 patients hospitalized with heart failure across 60 US hospitals to torsemide versus furosemide, using a hierarchical composite outcome of all-cause mortality, recurrent hospitalizations, and improvement in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score, with inverse probability weighting and subgroup and sensitivity analyses.
Key findings
- In the primary 12-month intention-to-treat analysis, the adjusted win ratio was 1.07 (95% CI 0.98-1.16, p=.13), indicating no significant difference between torsemide and furosemide.
- A supplementary 30-month analysis yielded a similar result (adjusted win ratio 1.06, 95% CI 0.98-1.16, p=.14).
- As-treated sensitivity analyses were consistent with the neutral primary findings; exploratory subgroup analyses were not adjusted for multiplicity and are considered hypothesis-generating.
Clinical relevance
This confirms, using a more comprehensive outcome framework that accounts for mortality, hospitalizations, and symptoms or quality of life together, that there is no clear advantage of torsemide over furosemide, or vice versa, for managing heart failure congestion, supporting either loop diuretic as a reasonable choice.
Who should care
Limitations
This is a secondary, exploratory analysis of a trial that was not powered specifically for the win-ratio outcome; subgroup findings are explicitly noted as hypothesis-generating and not adjusted for multiple comparisons.
Using a comprehensive outcome measure combining survival, hospitalizations, and quality of life, neither torsemide nor furosemide showed a clear advantage for treating heart failure, confirming these two loop diuretics are comparable options.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Loop diuretics are widely used for managing congestion in patients with heart failure (HF). The TRANSFORM-HF trial is a multicenter randomized study that enrolled heart failure patients, comparing a strategy of torsemide vs furosemide. The time-to-event analysis demonstrated neutral effects on all-cause death at 30 months and the composite of all-cause death and first rehospitalization at 12 months. We evaluated whether a hierarchical win-ratio (WR) framework integrating mortality, recurrent hospitalization, and patient-reported health status provides additional interpretive insight.
Methods
This study is a secondary analysis of the pragmatic, multicenter, open-label, randomized TRANSFORM-HF trial, conducted across 60 US hospitals that randomized 2,859 patients hospitalized with HF to torsemide or furosemide. The primary 12-month hierarchical composite outcome was defined as (1) all-cause mortality, (2) recurrent all-cause hospitalizations, and (3) lack of improvement in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS). The primary statistical method was a WR analysis adjusting covariates via inverse probability weighting. Subgroup analyses evaluated potential heterogeneity across patient demographics and clinical characteristics.
Results
In the primary 12-month intention-to-treat analysis, the adjusted WR was 1.07 (95% CI, 0.98-1.16; P = .13), indicating no significant difference between torsemide and furosemide. A supplementary 30-month analysis with extended mortality follow-up yielded a similar estimate (adjusted WR, 1.06; 95% CI, 0.98-1.16; P = .14); hospitalization and KCCQ-CSS components were assessed through 12 months. As-treated sensitivity analyses were consistent with the neutral primary findings. Exploratory subgroup analyses were not adjusted for multiplicity and should be considered hypothesis-generating.
Conclusions
The overall WR comparison between torsemide and furosemide showed no statistically significant difference in the primary 12-month analysis. The WR framework provided an interpretive decomposition across outcome domains but did not establish superiority of either loop diuretic strategy. All findings should be considered exploratory.
Trial registration
ClinicalTrials.gov, NCT03296813, https://clinicaltrials.gov/study/NCT03296813.
DOI
10.1016/j.ahj.2026.107525
PMID
42419438
PMCID
PMC13450815
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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