Loop Diuretics and Mortality in Heart Failure: A Propensity Score–Matched Study

Background

While loop diuretics remain a cornerstone of heart failure (HF) management, evidence directly comparing the clinical outcomes of torasemide and furosemide is still not clear.

Objectives

We aimed to assess the comparison of mortality between furosemide and torasemide in patients with HF.

Methods

This single-center, retrospective, and observational cohort study included 627 patients with HF who were regularly prescribed furosemide or torasemide and were admitted to the emergency department or cardiology outpatient clinic between January 1, 2022, and June 30, 2023. Patients were divided into the two groups as follows: the furosemide group and the torasemide group. The primary outcome was defined as 1-year all-cause mortality. The primary outcome was assessed by Kaplan−Meier analyses in the whole study population and the 1:1 propensity score−matched cohort.

Results

Of 627 eligible patients with HF, 497 were treated with furosemide, while 130 received torasemide. After propensity score matching analysis, 82 patients with HF in the furosemide group were compared with 82 patients with HF in the torasemide group. In the furosemide group, 1-year all-cause mortality was observed in 15 (18.3%) patients with HF, compared to 13 (15.9%) patients with HF in the torasemide group (p: 0.678). Kaplan−Meier analysis showed that cumulative survival rates were comparable between the HF patients treated with furosemide and those treated with torasemide (log-rank p: 0.661).

Conclusions

In patients with HF, treatment with torasemide was associated with similar 1-year all-cause mortality compared to furosemide, underscoring the absence of a detectable prognostic difference between the two loop diuretic strategies.