{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T22:09:02Z","timestamp":1793484542682,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Evidence on the real\u2010world comparative effectiveness and safety of commonly used loop diuretics for heart failure is mixed, particularly among older adults who are at a higher risk of adverse outcomes. Thus, we aimed to compare the outcomes and safety profiles of torsemide and furosemide.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a new user, active comparator retrospective cohort study comparing torsemide to furosemide in Medicare fee\u2010for\u2010service beneficiaries with heart failure in claims data (2008\u20132020). Effectiveness outcomes were a composite of heart failure hospitalization or death and urgent outpatient visits requiring intravenous diuretics; safety outcomes included acute kidney injury, hypovolemia, and hypokalemia. We used 1:4 propensity score (PS) matching to adjust for confounding. We calculated PS\u2010matched hazard ratios using Cox proportional hazard models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Across 328\u2009640 matched beneficiaries, compared with furosemide, torsemide was associated with a similar, though statistically significantly lower, risk of the composite effectiveness outcome (hazard ratio [HR]\u2009=\u20090.97, 95% CI:0.95,0.99; incidence rate difference (IRD)\u2009=\u2009\u22123.79, 95% CI:\u20109.38,1.81 events per 1000 person\u2010years) and lower risk for urgent visits with intravenous loop diuretics (HR\u2009=\u20090.88, 95% CI:0.84,0.92; IRD\u2009=\u2009\u22127.03, 95% CI:\u20109.79,\u22124.26 events per 1000 person\u2010years). Torsemide was also associated with an increased risk of acute kidney injury (HR\u2009=\u20091.12, 95% CI:1.10,1.15; IRD\u2009=\u200936.89, 95% CI:31.51,42.64 events per 1000 person\u2010years) with no observed difference in hypokalemia (HR\u2009=\u20091.02, 95% CI:0.91,1.14; IRD\u2009=\u20090.46, 95% CI:\u22120.51,1.42 events per 1000 person\u2010years) and hypovolemia (HR\u2009=\u20091.03, 95% CI:0.98,1.09; IRD\u2009=\u20092.36, 95% CI:0.15,4.56 events per 1000 person\u2010years).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Compared with furosemide, initiation of torsemide was associated with a slightly lower risk of a composite of all\u2010cause mortality or heart failure hospitalization and urgent visits with intravenous diuretics, but a slightly higher risk of acute kidney injury. In older adults, clinicians must balance torsemide's potential benefits with the acute kidney injury risk.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.70130","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T20:18:44Z","timestamp":1742933924000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Effectiveness and Safety of Torsemide Versus Furosemide in Older Adults With Heart Failure"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7262-9412","authenticated-orcid":false,"given":"Amina A.","family":"Alkhalaf","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Department of Pharmacy Practice College of Pharmacy, King Abdulaziz University  Jeddah Saudi 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