Importance Differences in clinical profiles, outcomes, and diuretic treatment effects may exist between patients with de novo heart failure (HF) and worsening chronic HF (WHF). Objectives To compare clinical characteristics and treatment outcomes of torsemide vs furosemide in patients hospitalized with de novo HF vs WHF. Design, Setting, and Participants All patients with a documented ejection fraction who were randomized in the Torsemide Comparison With Furosemide for Management of Heart Failure (TRANSFORM-HF) trial, conducted from June 18 through March 2022, were included in this post hoc analysis. Study data were analyzed March to May 2023. Exposure Patients were categorized by HF type and further divided by loop diuretic strategy. Main Outcomes and Measures End points included all-cause mortality and hospitalization outcomes over 12 months, as well as change from baseline in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS). Results Among 2858 patients (mean [SD] age, 64.5 [14.0] years; 1803 male [63.1%]), 838 patients (29.3%) had de novo HF, and 2020 patients (70.7%) had WHF. Patients with de novo HF were younger (mean [SD] age, 60.6 [14.5] years vs 66.1 [13.5] years), had a higher glomerular filtration rate (mean [SD], 68.6 [24.9] vs 57.0 [24.0]), lower levels of natriuretic peptides (median [IQR], brain-type natriuretic peptide, 855.0 [423.0-1555.0] pg/mL vs 1022.0 [500.0-1927.0] pg/mL), and tended to be discharged on lower doses of loop diuretic (mean [SD], 50.3 [46.2] mg vs 63.8 [52.4] mg). De novo HF was associated with lower all-cause mortality at 12 months (de novo, 65 of 838 [9.1%] vs WHF, 408 of 2020 [25.4%]; adjusted hazard ratio [aHR], 0.50; 95% CI, 0.38-0.66; P < .001). Similarly, lower all-cause first rehospitalization at 12 months and greater improvement from baseline in KCCQ-CSS at 12 months were noted among patients with de novo HF (median [IQR]: de novo, 29.94 [27.35-32.54] vs WHF, 23.68 [21.62-25.74]; adjusted estimated difference in means: 6.26; 95% CI, 3.72-8.81; P < .001). There was no significant difference in mortality with torsemide vs furosemide in either de novo (No. of events [rate per 100 patient-years]: torsemide, 27 [7.4%] vs furosemide, 38 [10.9%]; aHR, 0.70; 95% CI, 0.40-1.14; P = .15) or WHF (torsemide 212 [26.8%] vs furosemide, 196 [24.0%]; aHR, 1.08; 95% CI, 0.89-1.32; P = .42; P for interaction = .10), In addition, no significant differences in hospitalizations, first all-cause hospitalization, or total hospitalizations at 12 months were noted with a strategy of torsemide vs furosemide in either de novo HF or WHF. Conclusions and Relevance Among patients discharged after hospitalization for HF, de novo HF was associated with better clinical and patient-reported outcomes when compared with WHF. Regardless of HF type, there was no significant difference between torsemide and furosemide with respect to 12-month clinical or patient-reported outcomes.

中文翻译：

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托塞米与呋塞米在新发慢性心力衰竭患者与恶化慢性心力衰竭患者中的​​比较：TRANSFORM-HF 随机临床试验的子研究。

重要性 新发心力衰竭 (HF) 和慢性心力衰竭 (WHF) 恶化患者之间的临床特征、结局和利尿治疗效果可能存在差异。目的 比较托拉塞米与呋塞米治疗新发心力衰竭与 WHF 住院患者的临床特征和治疗结果。设计、设置和参与者 在 2022 年 6 月 18 日至 2022 年 3 月进行的托拉塞米与呋塞米治疗心力衰竭比较 (TRANSFORM-HF) 试验中随机分配的所有记录有射血分数的患者均纳入本次事后分析。研究数据于 2023 年 3 月至 5 月进行分析。暴露患者根据心力衰竭类型进行分类，并根据袢利尿策略进一步划分。主要结果和测量终点包括 12 个月内的全因死亡率和住院结果，以及堪萨斯城心肌病问卷临床总结评分 (KCCQ-CSS) 相对于基线的变化。结果 在 2858 名患者（平均 [SD] 年龄，64.5 [14.0] 岁；1803 名男性 [63.1%]）中，838 名患者（29.3%）患有新发 HF，2020 名患者（70.7%）患有 WHF。新发心力衰竭患者较年轻（平均 [SD] 年龄，60.6 [14.5] 岁 vs 66.1 [13.5] 岁），肾小球滤过率较高（平均 [SD]，68.6 [24.9] vs 57.0 [24.0]），利钠肽水平较低（中位[IQR]，脑型利尿肽，855.0 [423.0-1555.0] pg/mL vs 1022.0 [500.0-1927.0] pg/mL），并且倾向于在较低剂量的袢利尿剂中排出（平均 [SD]，50.3 [46.2] 毫克 vs 63.8 [52.4] 毫克）。新发 HF 与 12 个月时较低的全因死亡率相关（新发 838 例中的 65 例 [9.1%] 对比 2020 年 WHF，408 例 [25.4%]；调整后的风险比 [aHR]，0.50；95% CI，0.38 -0.66；P < .001)。同样，在新发心力衰竭患者中，12 个月时全因首次再住院率较低，12 个月时 KCCQ-CSS 较基线有较大改善（中位 [IQR]：新发 29.94 [27.35-32.54] 对比 WHF，23.68） [21.62-25.74]；调整后估计平均值差异：6.26；95% CI，3.72-8.81；P < .001）。托拉塞米与呋塞米两种治疗的死亡率均无显着差异（事件数[每 100 名患者年的发生率]：托拉塞米，27 [7.4%] vs 呋塞米，38 [10.9%]；aHR，0.70；95 % CI，0.40-1.14；P = .15）或 WHF（托塞米 212 [26.8%] 与呋塞米，196 [24.0%]；aHR，1.08；95% CI，0.89-1.32；P = .42；P 表示相互作用= .10)，此外，在新发 HF 或 WHF 中，托拉塞米与呋塞米策略在住院治疗、首次全因住院治疗或 12 个月总住院治疗方面没有显着差异。结论和相关性 在因心力衰竭住院后出院的患者中，与 WHF 相比，新发心力衰竭具有更好的临床和患者报告结果。无论心衰类型如何，托拉塞米和呋塞米在 12 个月的临床或患者报告的结果方面没有显着差异。