Torsemide versus furosemide in heart failure patients: insights from Duke University Hospital.

Abstract

Furosemide has historically been the primary loop diuretic in heart failure patients despite data suggesting potential advantages with torsemide. We used the Duke Echocardiography Lab Database to investigate patients admitted with heart failure to Duke Hospital from 2000 to 2010 who were discharged on either torsemide or furosemide. We described baseline characteristics based on discharge diuretic and assessed the relationship with all-cause mortality through 5 years. Of 4580 patients, 86% (n = 3955) received furosemide and 14% (n = 625) received torsemide. Patients receiving torsemide were more likely to be female and had more comorbidities compared with furosemide-treated patients. Survival was worse in torsemide-treated patients [5-year Kaplan-Meier estimated survival of 41.4% (95% CI: 36.7-46.0) vs. 51.5% (95% CI: 49.8-53.1)]. After risk adjustment, torsemide use was no longer associated with increased mortality (hazard ratio 1.16; 95% CI: 0.98-1.38; P = 0.0864). Prospective trials are needed to investigate the effect of torsemide versus furosemide because of the potential for residual confounding.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1097/FJC.0000000000000212

Publication Info

Mentz, Robert J, Jonathan Buggey, Mona Fiuzat, Mads K Ersbøll, Phillip J Schulte, Adam D DeVore, Eric L Eisenstein, Kevin J Anstrom, et al. (2015). Torsemide versus furosemide in heart failure patients: insights from Duke University Hospital. J Cardiovasc Pharmacol, 65(5). pp. 438–443. 10.1097/FJC.0000000000000212 Retrieved from https://hdl.handle.net/10161/11073.

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Scholars@Duke

Mentz

Robert John Mentz

Associate Professor of Medicine

I am a cardiologist with a clinical and research interest in heart failure (going from Failure to Function), including advanced therapies such as cardiac transplantation and mechanical assist devices or “heart pumps."

I serve our group as Chief of the Heart Failure Section.

I became a heart failure cardiologist in order to help patients manage their chronic disease over many months and years. I consider myself strongly committed to compassionate patient care with a focus on quality of life and patient preference.

I am the Editor in Chief of the Journal of Cardiac Failure - The official journal of the Heart Failure Society of America.

My research interests are focused on treating co-morbid diseases in heart failure patients and improving outcomes across the cardiovascular spectrum through clinical trials and outcomes research. Below, you will find my specific research interests:

  •     Cardiometabolic disease
  •     Co-morbidity characterization (diabetes, sleep apnea, renal failure) in heart failure
  •     Phenotypic characterization and risk prognostication of patients with heart failure
  •     Role of surrogate and nonfatal endpoints in clinical heart failure trials
  •     Biomarkers in heart failure
  •     Novel pharmacological and non-pharmacological approaches to heart failure
  •     Improving site-based heart failure research

Mona Fiuzat

Adjunct Associate Professor in the Department of Medicine
DeVore

Adam David DeVore

Associate Professor of Medicine

Adam D. DeVore, MD, MHS

Dr. DeVore is a cardiologist and Associate Professor of Medicine in the Department of Medicine, Division of Cardiology, at Duke University School of Medicine. His clinical interests include caring for patients and families with heart failure, including those with left ventricular assist devices and heart transplants. He is involved in and leads multiple large studies of patients with heart failure at both Duke University Medical Center and the Duke Clinical Research Institute. He currently serves as the medical director of the Duke Heart Transplant program.

He attended medical school at the University of Chicago Pritzker School of Medicine and completed internal medicine residency at Brigham and Women’s Hospital. He then pursued cardiology training at Duke University and solidified his interests in clinical research and heart failure. He completed a research fellowship at the Duke Clinical Research Institute and a Masters of Health Sciences in Clinical Research before completing an advanced heart failure fellowship at Duke University.

The overarching goals of his research are to advance the current understanding of heart failure through clinical trials as well as develop an evidence base for implementation strategies that addresses the gap between heart failure trial results and clinical practice. For example, he has served on the Steering Committees for large clinical trials, including PIONEER-HF and SPIRRIT-HFpEF. Dr. DeVore also published the first clinical trial conducted within the American Heart Association’s Get With The Guidelines-Heart Failure program, a registry-based cluster randomized trial of quality improvement interventions. He was also the principal investigator for CONNECT-HF, a large-scale, pragmatic, cluster-randomized trial at 161 sites in the US evaluating heart failure quality improvement initiatives. Outside of his work on heart failure, Dr. DeVore is  married with 4 children and spends his time corralling them all and coaching youth baseball.

 

 

Eric Leo Eisenstein

Associate Professor Emeritus in Medicine

Research Interests:

Dr. Eisenstein is a member of the Duke Clinical Research Institute’s Outcomes Research and Assessment Group, with a special interest in understanding the relationships between complex interventions in health care systems and the long-term clinical and economic outcomes of patients. He has served as Principal Investigator for phase II, III, and IV economic and quality of life studies conducted alongside randomized clinical trials in cardiovascular, emergency, pulmonary, and vascular medicine and surgery. He also has conducted health technology evaluations making use of innovative research methods designed to better understand key relationships in observation (non-randomized) patient data. This work has included evaluations of the long-term clinical outcomes of coronary artery disease patients receiving drug-eluting vs. bare metal intracoronary stents, and how the use of clopidogrel changes those relationships. He also has conducted several studies assessing factors contributing to the costs of and evaluating different design considerations for multi-center randomized clinical trials.

In addition to his working in traditional health technology evaluation, Dr. Eisenstein has an interest in evaluating information technologies as interventions in health care systems. In this regard, he has collaborated in the design and conduct of large-scale, randomized clinical trials to evaluate clinical decision support systems. The research objective in these studies has been to develop methods for evaluating health information technologies in practice-based settings using a “tool kit” of inexpensive, yet highly scalable methods that make use of data sets created as a byproduct of normal clinical and administrative operations. The use of these evaluation methods has been demonstrated in four clinical trials that include care process, clinical, economic, and quality of life measurements.

Anstrom

Kevin J. Anstrom

Adjunct Professor in the Department of Biostatistics & Bioinformatics

My research interests include clinical trial design, causal inference, coordinating centers, data monitoring, and pragmatic clinical research.


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