TRANSFORM-HF Mortality Comparison Index

TRANSFORM-HF Mortality Comparison Index: Explanation and Clinical Context The TRANSFORM-HF Mortality Comparison Index is derived from the TRANSFORM-HF trial (Felker GM, et al., NEJM 2022), which compared torsemide and furosemide in patients hospitalized with heart failure. The trial demonstrated no statistically significant difference in all-cause mortality at 12 months between the two diuretics (26.1% vs 26.2%; HR 1.02, 95% CI 0.89–1.18). This calculator applies multivariable clinical parameters—age, ejection fraction, renal function, systolic blood pressure, NYHA class, diabetes, and sex—to generate an individualized 12-month mortality estimate based on logistic regression modeling approximated from the trial data.

It also allows direct comparison between loop diuretic choices (torsemide vs furosemide). While torsemide has favorable pharmacokinetic properties and may improve symptom control or hospital readmission rates in some patients, the mortality advantage remains unproven. This index serves as an interpretive, educational, and comparative aid rather than a definitive prognostic model.

Clinical Interpretation Summary: Values above 30% reflect high 12-month mortality risk, typically associated with advanced heart failure, renal dysfunction, or low blood pressure. A torsemide-related modest reduction (up to 5%) in predicted mortality is modeled here to reflect observed hazard trends, but should not guide therapy independently of clinical context.