Comparative Analysis of Long-Term Outcomes of Torasemide and Furosemide in Heart Failure Patients in Heart Failure Registries of the European Society of Cardiology

  • Krzysztof Ozierański
  • Paweł BalsamEmail author
  • Agnieszka Kapłon-Cieślicka
  • Agata Tymińska
  • Robert Kowalik
  • Marcin Grabowski
  • Michał Peller
  • Anna Wancerz
  • Michał Marchel
  • Maria G. Crespo-Leiro
  • Aldo P. Maggioni
  • Jarosław Drożdż
  • Krzysztof J. Filipiak
  • Grzegorz Opolski



Current clinical recommendations do not emphasise superiority of any of diuretics, but available reports are very encouraging and suggest beneficial effects of torasemide. This study aimed to compare the effect of torasemide and furosemide on long-term outcomes and New York Heart Association (NYHA) class change in patients with chronic heart failure (HF).


Of 2019 patients enrolled in Polish parts of the heart failure registries of the European Society of Cardiology (Pilot and Long-Term), 1440 patients treated with a loop diuretic were included in the analysis. The main analysis was performed on matched cohorts of HF patients treated with furosemide and torasemide using propensity score matching.


Torasemide was associated with a similar primary endpoint (all-cause death; 9.8% vs. 14.1%; p = 0.13) occurrence and 23.8% risk reduction of the secondary endpoint (a composite of all-cause death or hospitalisation for worsening HF; 26.4% vs. 34.7%; p = 0.04). Treatment with both torasemide and furosemide was associated with the significantly most frequent occurrence of the primary (23.8%) and secondary (59.2%) endpoints. In the matched cohort after 12 months, NYHA class was higher in the furosemide group (p = 0.04), while furosemide use was associated with a higher risk (20.0% vs. 12.9%; p = 0.03) of worsening ≥ 1 NYHA class. Torasemide use impacted positively upon the primary endpoint occurrence, especially in younger patients (aged < 65 years) and with dilated cardiomyopathy.


Our findings contribute to the body of research on the optimal diuretic choice. Torasemide may have advantageous influence on NYHA class and long-term outcomes of HF patients, especially younger patients or those with dilated cardiomyopathy, but it needs further investigations in prospective randomised trials.


Heart failure Loop diuretic Furosemide Torasemide 


Contribution Statement

KO conceived of the idea for the study and performed the statistical analysis. KO and PB designed the analysis, conducted the data interpretation and wrote the manuscript. KO, PB, AKC, AT, RK, MG, MP, AW and MM researched the data. KJF and GO reviewed the manuscript. MGCL and APM designed and coordinated the registries. JD coordinated the registry nationwide. All authors edited and approved the final version of the manuscript.


The study is financed from the statutory funds of the European Society of Cardiology (ESC).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Krzysztof Ozierański
    • 1
  • Paweł Balsam
    • 1
    Email author
  • Agnieszka Kapłon-Cieślicka
    • 1
  • Agata Tymińska
    • 1
  • Robert Kowalik
    • 1
  • Marcin Grabowski
    • 1
  • Michał Peller
    • 1
  • Anna Wancerz
    • 1
  • Michał Marchel
    • 1
  • Maria G. Crespo-Leiro
    • 2
  • Aldo P. Maggioni
    • 3
    • 4
  • Jarosław Drożdż
    • 5
  • Krzysztof J. Filipiak
    • 1
  • Grzegorz Opolski
    • 1
  1. 1.Department of Cardiology, Public Central Teaching Hospital in WarsawMedical University of WarsawWarsawPoland
  2. 2.Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario A CorunaCIBERCVLa CorunaSpain
  3. 3.ANMCO Research CentreFlorenceItaly
  4. 4.EURObservational Research ProgrammeEuropean Society of CardiologySophia AntipolisFrance
  5. 5.Department of Cardiology, Cardiology and Cardiac SurgeryMedical University of LodzLodzPoland

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