There is a lack of large-scale randomized trials comparing different loop diuretics, despite their common use in clinical practice.  The TRANSFORM-HF trial, conducted by Dr. Stephen Greene and colleagues from the Duke Clinical Research Institute, aimed to determine the effects of torsemide and furosemide on patient-reported outcomes and quality of life in individuals with heart failure.

The study employed a pragmatic approach, allowing routine clinical care without requiring in-person visits. Instead, centralized follow-up procedures, including the use of the National Death Index and telephone call centre from the Duke Clinical Research Institute, were implemented to collect patient-reported outcome data and other relevant information.

At the ESC HFA meeting, the trial presented the effects on two prespecified patient-reported outcomes: the change in KCCQ Clinical Summary score (a measure of quality of life) and the PHQ two score (a screening tool for depression). The results showed no significant difference in the change from baseline in the KCCQ Clinical Summary score or the likelihood of having a PHQ two score greater than three between the torsemide and furosemide strategies at different follow-up intervals. Furthermore, there were no significant disparities observed in the likelihood of having a PHQ-2 score greater than three between the two diuretic strategies.

These findings were consistent across various subgroups analyzed, indicating the choice between torsemide and furosemide does not have a significant impact on symptom improvement or quality of life in heart failure patients. Dr Stephen Greene commented; “focusing on which loop diuretic to use should not be a priority for spending in clinical time. Instead, our clinical time is better spent focusing on one, ensuring optimal loop diuretic dosing rather than the agent, but also, most importantly, timely optimization of guideline-directed medical therapy.”¹

Dr Greene continued; outlining the unanswered questions yet to be addressed regarding the choice of loop diuretic; “what should they be paired with, if anything, in terms of a second adjunctive diuretic? What is the optimal dosing? […] What about the patients that are maybe struggling on one loop diuretic? And in those situations which again were not eligible for TRANSFORM, would it make sense to switch them to a different strategy, a different agent […]?”.²