Article Impact Level: HIGH Data Quality: STRONG Summary of The American Journal of Cardiology, 210, 208–216. https://doi.org/10.1016/j.amjcard.2023.08.162 Dr. Arti Virkud et al.
Points
- The study compared the effects of loop diuretic prescribing at heart failure (HF) hospitalization discharge on mortality and HF readmission, focusing on furosemide, torsemide, and bumetanide.
- Analysis of Medicare claims data from 2007 to 2017 revealed that torsemide had the lowest adjusted 6-month all-cause mortality risk (13.2%), followed by furosemide (14.5%) and bumetanide (15.6%).
- Similarly, the 6-month composite outcome risk was 21.4% for torsemide, 24.7% for furosemide, and 24.9% for bumetanide, indicating clinically essential differences in morbidity among older patients.
- Compared with furosemide, torsemide had a 1.3% lower 6-month all-cause mortality risk and a 3.3% lower 6-month composite outcome risk. Bumetanide showed a 1.0% higher 6-month all-cause mortality risk and a 0.2% higher 6-month composite outcome risk.
- The study emphasized the significance of the initial loop diuretic choice in optimizing patient outcomes in HF management, highlighting the favorable risk profile of torsemide compared to furosemide and bumetanide.
Summary
The research aimed to compare the impact of loop diuretic prescribing at heart failure (HF) hospitalization discharge on mortality and HF readmission, focusing on furosemide, torsemide, and bumetanide. The study utilized Medicare claims data from 2007 to 2017. It estimated the 6-month risks of all-cause mortality and a composite outcome (HF readmission or all-cause mortality) using inverse probability of treatment weighting to adjust for relevant confounders. The analysis included 62,632 furosemide, 1,720 torsemide, and 2,389 bumetanide initiators. The adjusted 6-month all-cause mortality risk was found to be lowest for torsemide (13.2%), followed by furosemide (14.5%) and bumetanide (15.6%). Similarly, the 6-month composite outcome risk was 21.4% for torsemide, 24.7% for furosemide, and 24.9% for bumetanide.
The results indicated clinically essential differences in morbidity among older patients receiving torsemide, bumetanide, or furosemide as the first prescribed loop diuretic following HF hospitalization. Specifically, compared with furosemide, torsemide was associated with a 1.3% lower 6-month all-cause mortality risk and a 3.3% lower 6-month composite outcome risk. Conversely, bumetanide showed a 1.0% higher 6-month all-cause mortality risk and a 0.2% higher 6-month composite outcome risk compared to furosemide, although these differences were not statistically significant.
In conclusion, the study highlighted the potential impact of the initial loop diuretic choice on morbidity outcomes in older HF patients, with torsemide demonstrating a favorable risk profile compared to furosemide and bumetanide. These findings underscore the importance of considering the specific loop diuretic selection in managing HF to optimize patient outcomes.
Link to the article: https://www.ajconline.org/article/S0002-9149(23)00941-4/abstract
References Virkud, A. V., Chang, P. P., Funk, M. J., Kshirsagar, A. V., Edwards, J. K., Pate, V., Kosorok, M. R., & Gower, E. W. (2024). Comparative Effect of Loop Diuretic Prescription on Mortality and Heart Failure Readmission. The American Journal of Cardiology, 210, 208–216. https://doi.org/10.1016/j.amjcard.2023.08.162
