BRIEF RESEARCH REPORT article
Front. Pharmacol.
Sec. Cardiovascular and Smooth Muscle Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1643077
This article is part of the Research TopicNew Frontiers in Heart Failure Therapy: Mechanisms, Efficacy, and ChallengesView all 8 articles
Comparative analysis of furosemide and torsemide efficacy in 24 hours of acute heart failure admission
Provisionally accepted
Małgorzata Małek-Elikowska*
Andrzej Szyszka
Julita Fedorowicz
Rafał DankowskiCyntia SzymańskaArtur Baszko- Faculty of Medicine, Poznan University of Medical Sciences, Poznań, Poland
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Background: Intravenous (IV) furosemide and torsemide represent a cornerstone of guideline-directed medical therapy for acute heart failure (AHF). However, the evidence regarding the superiority of each agent remains controversial.The prospective, open-label, comparative study included 51 adult patients hospitalized due to AHF. Torsemide was administered to 25 patients (49%), and furosemide to 26 patients (51%). The primary endpoint was the change in urinary spot sodium level at 24 hours, used to assess diuretic efficacy. Secondary outcomes included lung ultrasound (LUS) B-lines, clinical status evaluation based on the Borg scale, Killip-Kimball classification, and daily urine output.After 24 hours of treatment, urinary sodium levels increased by an estimated marginal mean (EMM) of 21.84 mmol/L in the furosemide group and 0.97 mmol/L in the torsemide group (p=0.173). The number of B-lines over 24 hours decreased, with an EMM of 28.31 in the furosemide group, and 30.12 in the torsemide group (p=0.779). The severity of dyspnea, measured by the Borg scale, decreased over 24 hours with an EMM of 3.58 points in the furosemide group, and 3.62 points in the torsemide group (p=0.891). Pulmonary congestion, measured by the Killip-Kimball classification, minimized with an EMM of 0.42 points in the furosemide group, and 0.47 points in the torsemide group (p=0.770). Daily urine output after 24 hours of treatment reached an EMM of 3559.67 mL in the furosemide group, and 2734.89 mL in the torsemide group (p=0.068).Both furosemide and torsemide demonstrated comparable efficacy in the initial treatment of AHF, as assessed by laboratory, ultrasound, and clinical parameters
Keywords: Furosemide, Torsemide, acute heart failure, Urinary sodium, B-lines, Loop diuretics
Received: 07 Jun 2025; Accepted: 14 Jul 2025.
Copyright: © 2025 Małek-Elikowska, Szyszka, Fedorowicz, Dankowski, Szymańska and Baszko. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Małgorzata Małek-Elikowska, Faculty of Medicine, Poznan University of Medical Sciences, Poznań, Poland
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