Torsemide versus Furosemide Therapy in Patients with Chronic Heart Failure: An updated Meta-analysis
Bibliographic record
Abstract
Introduction : Torsemide’s oral bioavailability and half-life theoretically render it a more efficient diuretic than Furosemide, but the clinical outcomes of torsemide compared with furosemide remain unclear. A rigorous meta-analysis performed by Bishoy et al 2019 showed Torsemide as compared to Furosemide improved hospitalization though it was not statistically significant. We performed an updated meta-analysis to evaluate the effects of Torsemide vs. Furosemide in heart failure hospitalization and mortality. Methods : In addition to the studies included in previous meta-analyses, we performed a literature search using Medline from 2019 till 07/25/2023. We used the MESH term ‘Torsemide’ AND ‘Furosemide[Mesh]) AND ‘Heart Failure’. Eligible studies were 1) Randomized control studies (RCT), non-RCT, and observational prospective and retrospective cohort studies, 2) with English abstract 3) compared torsemide with furosemide, and 4) assessed outcomes of all-cause hospitalization or all-cause mortality. When studies reported both short-term and long-term outcomes, a preference was given to long-term outcomes. Study quality was assessed by the Ottawa scale. RevMan 5.4 was used for analysis. Study results were analyzed using a random effects model. I2 statistics were applied to assess the between-study heterogeneity. Further subgroup analysis was performed for RCTs only. Results : In addition to the previous studies, our literature search returned 27 studies. Two studies met the inclusion criteria. A total of twenty studies (8 randomized control trials [RCTs] and 12 observational studies) with a total of 22,749 patients were included. New-Castle Ottawa scale was used to assess the quality of each study, score of each study ranged from 7 to 9 which reflected high quality. Intra-study risks of bias were also assessed. During a mean follow-up duration of 12 months, risk of hospitalization due to heart failure in patients treated with Torsemide was not different from those treated with Furosemide (odds ratio [OR] 0.80, 95% confidence interval [CI] [0.59, 1.07], p< 0.23, I2 = 24%) also no difference in risk of all-cause mortality (odds ratio [OR] 0.94, 95% confidence interval [CI] [0.87, 1.02], p< 0.001, I2 = 96%, respectively) noted between the two groups. The results remained consistent when subgroup analysis was conducted using only RCTs. Conclusions : Compared with Furosemide, Torsemide use was not associated with a significant difference in hospitalization for heart failure or all-cause mortality in patients with heart failure. The studies included in hospitalization analyses showed lower heterogeneity while for all-cause mortality a higher heterogeneity was noted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.025 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.057 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".