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  • Posted January 19, 2023

Is There a Best Diuretic Drug for Heart Failure?

It doesn't matter which water pill you're prescribed to treat your heart failure, because new trial data shows that one works as well as the other.

Two diuretics widely used to treat heart failure, furosemide and torsemide, showed no difference in their ability to improve patient survival, according to the U.S. National Institutes of Health (NIH)-sponsored trial.

“We're not saying that patients don't need diuretics. We're saying that there's no difference in the survival benefit of these two therapies,” said study co-leader Dr. Robert Mentz, chief of the heart failure section at Duke University Medical Center in Durham, N.C.

“This suggests we should be spending more time focusing on the right diuretic dose for our patients and working to treat patients with therapies that improve clinical outcomes in heart failure,” Mentz added in an NIH news release.

More than 6 million American adults live with heart failure, which is most common in people aged 65 and older, according to the U.S. Centers for Disease Control and Prevention. It occurs when the heart grows too weak to pump enough blood to meet the body's needs.

Diuretics help relieve congestion and breathing difficulties caused by fluid build-up in patients with heart failure.

Furosemide is the most used diuretic for heart failure and has been around for decades, while torsemide is comparatively newer. The investigators launched the new clinical trial after previous studies suggested that torsemide might be better at reducing deaths.

For the trial, the researchers studied more than 2,800 patients hospitalized with heart failure at 60 hospitals throughout the United States. The patients randomly received one of the two diuretics, and doctors followed them for an average of 17 months.

During follow-up, 26% of patients taking either torsemide or furosemide died, the study authors said.

“Overall, our study showed that torsemide did not improve survival compared to furosemide in this high-risk population of patients with heart failure, and we also observed similar rates of hospitalization with the two medications,” Mentz said.

The study also pointed out the need for improved diuretics and other treatments for heart failure, given that the death rate in both groups was so high.

The findings were published Jan. 17 in the Journal of the American Medical Association.

“What this trial also tells us is that there's still a lot of work to do to improve care and outcomes for patients with heart failure,” said Dr. David Goff, director of cardiovascular sciences with the U.S. National Heart, Lung, and Blood Institute.

“More studies are needed, and NIH is actively exploring better ways to treat heart failure as well as prevent it from occurring,” said Goff, who was not part of the study team.

More information

The American Heart Association has more about heart failure medications.

SOURCE: U.S. National Institutes of Health, news release, Jan. 17, 2023

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