Thread by @WilfriedMullens

Breaking News @AHAScience with #TRANSFORMHF - the largest (N=2859) ambulatory #heartfailure diuretic trial to determine if torsemide would be superior to furosemide to ⬇️ reduce all-cause mortality - what a huge accomplishment of @robmentz et al!!! (1/9)
sciencedirect.com/science/articl…

At first sight 'no need to transform your practice' as both are similarly effective for mortality (2/9)

Also similar for mortality and all-cause hospitalizations (3/9)

But @robmentz et al should be congratulated for conducting this very important RCT designed to answer an important clinically very relevant question. The pragmatic design allowed to recruit a large diverse patient population (>1/3 women, >1/3 black adults, HFpEF and HFrEF) (4/9)

Unfortunately, the pragmatic design did not allow to collect data on the prevalence of decongestion which is important as NTproBNP levels were almost 4000 pg/ml at inclusion. More insights on diuretic dosing or other GDMT might have led to a different result. (5/9)

Loop diuretics are the only drug with a class I recommendation independent of LVEF to treat signs and symptoms of congestion but decisive evidence regarding diuretic agents, administration schedules, and routes of administration was limited. (6/9)

#ADVOR clearly demonstrated that the addition of acetazolamide to loop diuretic therapy in patients with ADHF resulted in a greater incidence of successful decongestion. (7/9)
nejm.org/doi/10.1056/NE…

#CLOROTIC demonstrated that the addition of hydrocholorothiazide to loop diuretic therapy in patients with ADHF resulted in greater weight loss #HeartFailure2022 (8/9)

So do you feel we need to update the guidelines on diuretic therapy in HF ????? (9/9)
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