Torasemide in chronic heart failure: results of the TORIC study

BACKGROUND: Diuretics such as torasemide are commonly used to treat chronic heart failure (CHF). AIMS: The objective of the TOrasemide In Congestive Heart Failure (TORIC) Study was to investigate the safety, tolerability and efficacy of torasemide in CHF patients compared to furosemide or other diuretics in an open-label, non-randomised, post-marketing surveillance trial. METHODS: The present analysis shows the findings of 1377 patients with New York Heart Association (NYHA) class II-III CHF who received diuretic therapy with torasemide 10 mg/day orally (n=778) vs. patients who received furosemide 40 mg/day orally (n=527) or other diuretics (n=72) on top of their existing standard CHF therapy for 12 months. Besides safety and tolerability, efficacy was assessed by documentation of mortality, morbidity, functional class and serum potassium levels every 3 months. RESULTS: TORIC confirmed the safety and tolerability of torasemide in CHF patients. Mortality was significantly lower in the torasemide (n=17, 2.2%) than in the furosemide/other diuretics group (n=27, 4.5%) (P<0.05). Functional improvement as assessed by NYHA class was observed in more patients who received furosemide torasemide (n=356, 45.8%) than those who received furosemide/other diuretics (n=223, 37.2%) (P=0.00017). At the end of the study abnormally low serum potassium levels were observed in fewer torasemide (n=95, 12.9%) than furosemide/other diuretics patients (n=102, 17.9%) (P=0.013). CONCLUSION: Torasemide is safe and well tolerated in CHF patients. Although not designed as a mortality study, TORIC suggests a lower mortality amongst CHF patients treated with torasemide compared to furosemide/other diuretics. A functional improvement and a lower incidence of abnormal serum potassium levels were also observed in patients receiving torasemide as compared to those receiving furosemide/other diuretics.