Should torsemide be the loop diuretic of choice in systolic heart failure?

Future Cardiol. 2012 Sep;8(5):707-28. doi: 10.2217/fca.12.54.


Furosemide is the most widely prescribed loop diuretic in the setting of systolic heart failure (HF), yet torsemide has been shown to have less inter- and intra-individual variation in bioavailability and a longer duration of action compared with furosemide. Thus, a systematic review and meta-analysis of randomized controlled trials comparing torsemide versus furosemide in patients with systolic HF using OVID MEDLINE, Excerpta Medica (Embase), Web of Science, PubMed and Google Scholar was performed. Extracted data included study design, sample characteristics, intervention, outcomes and control for potential confounding factors. A DerSimonian and Laird random-effects model was used to compute summary risk ratios for HF and cardiovascular (CV) readmission outcomes. Two randomized trials comparing furosemide with torsemide in 471 patients with systolic HF were identified. Compared to furosemide, torsemide significantly reduced total HF readmissions (relative risk [RR]: 0.41, 95% CI: 0.28-0.61, p < 0.0001) and HF readmissions (RR: 0.53, 95% CI: 0.33-0.84, p = 0.008) as well as CV readmissions (RR: 0.77, 95% CI: 0.60-0.98, p = 0.03) in patients with "at least 1 readmission." Moreover, compared with furosemide, torsemide caused a 14% reduction in all-cause mortality (RR: 0.86 [0.53-1.39], p = 0.54). Compared with furosemide, torsemide significantly reduces HF and CV-related hospital readmissions in systolic HF. Furthermore, torsemide is associated with a trend in reducing all-cause mortality.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Confidence Intervals
  • Heart Failure, Systolic / drug therapy*
  • Heart Failure, Systolic / mortality
  • Heart Failure, Systolic / pathology
  • Humans
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Receptors, Mineralocorticoid
  • Risk
  • Sodium Potassium Chloride Symporter Inhibitors / adverse effects
  • Sodium Potassium Chloride Symporter Inhibitors / pharmacokinetics
  • Sodium Potassium Chloride Symporter Inhibitors / therapeutic use*
  • Sulfonamides / adverse effects
  • Sulfonamides / pharmacokinetics
  • Sulfonamides / therapeutic use*
  • Torsemide
  • United States


  • Mineralocorticoid Receptor Antagonists
  • Receptors, Mineralocorticoid
  • Sodium Potassium Chloride Symporter Inhibitors
  • Sulfonamides
  • Torsemide