Modified On-Treatment Analysis Confirms Results of TRANSFORM-HF


Veraprapas Kittipibul, MD, discusses an analysis of the TRANSFORM-HF trial at ACC.24.

A modified on-treatment analysis of the TRANSFORM-HF trial presented at the American College of Cardiology 2024 (ACC.24) Annual Scientific Sessions showed no meaningful changes in study outcomes between torsemide and furosemide treatment in heart failure hospitalizations after discharge.

“Even with that, we still saw the same result: that there was no difference between these 2 medications,” explained Veraprapas Kittipibul, MD, cardiology and research fellow at Duke University Medical Center, in an interview with HCPLive. “And back to your point we shouldn't be debating about which one is better but how can we maybe find the right dose for the right patient.”

TRANSFORM-HF was an open-label, pragmatic trial, in which older adults hospitalized with heart failure, regardless of ejection fraction, from 60 sites in the US were randomized in a 1:1 ratio to either torsemide or furosemide. Similar to the main findings, a pre-specified on-treatment analysis exhibited no differences, but statistical power may have been limited by unknown diuretic status in many patients.

This modified on-treatment analysis of TRANSFORM-HF was inclusive of patients alive with known or unknown diuretic status, assuming patients continued an assigned diuretic unless confirmed otherwise. The on-treatment definition was applied at both the time of discharge and 1-month follow-up. Outcomes for the analysis consisted of 12-month all-cause mortality and hospitalization.

A total of 2570 and 2374 patients were included in the on-treatment analysis at discharge and 1-month follow-up, respectively. Among this population, 97 (4%) and 675 (28%) had unknown diuretic status at discharge and 1-month follow-up.

Upon analysis, there were no significant differences in mortality outcomes between the on-treatment groups of torsemide versus furosemide at discharge (hazard ratio [HR], 1.01; P = .96) or 1-month (HR, 1.02; P = .90). Analyses also revealed no significant difference in all-cause hospitalization between the treatment groups at discharge (HR, 0.90; P = .12) and 1-month (HR, 0.91; P = .17).

For more insight into the study, watch the full interview with Kittipibul at ACC.24.


  1. Kittipibul V, Mentz RJ, Clare RM, et al. MODIFIED ON-TREATMENT ANALYSIS OF THE EFFECTS OF TORSEMIDE VS FUROSEMIDE AFTER DISCHARGE IN PATIENTS HOSPITALIZED WITH HEART FAILURE: RESULTS FROM TRANSFORM-HF. Presented at: American College of Cardiology (ACC.24) Annual Scientific Session. April 6 – 8, 2024. Atlanta, GA.
  2. Campbell P. Torsemide provides no benefit over furosemide for mortality, hospitalization in heart failure. HCP Live. November 5, 2022. Accessed April 8, 2024.
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