Abstract 14826: Effect of Torsemide vs Furosemide After Discharge for Acute Heart Failure Across the Spectrum of Left Ventricular Ejection Fraction: Observations From Transform-HF

Introduction: TRANSFORM-HF trial showed no significant difference in mortality or hospitalization outcomes in patients randomized to torsemide (T) versus furosemide (F) following a heart failure (HF) hospitalization (HFH). However, outcomes and responses to some therapies differ across ejection fraction (EF) subgroups.

Methods: We compared baseline patient characteristics and described treatment effects for various endpoints in TRANSFORM-HF stratified by EF: HF with reduced (EF≤40%;HFrEF) vs mildly reduced (41-49%;HFmrEF) vs preserved (≥50%;HFpEF) EFs. We also evaluated the prognostic association between EF and outcomes. Study endpoints were all-cause mortality and hospitalization at 30 days and 12 months (separately and as composites), and total hospitalizations.

Results: Our analysis included 2635 patients with EF data. Participants with HFpEF were older (72 [62-79] years) with lower eGFR (52 [36-72] ml/min/1.73m ² ) compared to the other EF cohorts, while patients with HFrEF had lower systolic blood pressure (112 [101-125] mmHg) and higher NT-proBNP levels (4554 [2368-9620] pg/ml). The neutral treatment effect for all studied endpoints did not differ across EF groups (all interaction p-values>0.05, Figure 1A). There was no significant difference in the rates of mortality and/or hospitalization at 12 months between patients in the three EF groups (HFrEF 59.2, HFmrEF 61, HFpEF 63 events/100 patient-years, p=0.24, Figure 1B). Even after adjusting for covariates the relative risk or rate ratio for all endpoints did not differ across EF groups.

Conclusions: Despite baseline differences between EF cohorts in TRANSFORM-HF, there were no significant differences in the study endpoints with T versus F across the EF spectrum. In contrast to previous observations, the adjusted risk ratios for all study endpoints did not differ by baseline EF. Following a HFH, there is substantial risk for all-cause mortality and subsequent hospitalization independent of EF.