Torsemide can be used for long-term management of congestive heart failure in equids: a description of 12 cases (2019–2024)

Kavita Shroff New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA

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 VMD https://orcid.org/0009-0001-9939-282X
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Darko Stefanovski New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA

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 PhD
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Virginia B. Reef New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA

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 DVM, DACVIM
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Marc S. Kraus Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA

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 DVM, DACVIM
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Cristobal Navas de Solis New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA

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 LV, PhD, DACVIM

Abstract

OBJECTIVE

Information about congestive heart failure (CHF) treatment in the horse is limited. Torsemide, an oral loop diuretic, is increasingly used in humans, dogs, and cats with CHF. Torsemide is well absorbed and induces diuresis in healthy horses, and its use in a horse with CHF has been reported. This retrospective descriptive study aimed to describe the use of torsemide in equids with CHF.

ANIMALS

12 equids (10 horses, 1 miniature donkey, and 1 mule).

CLINICAL PRESENTATION

Horses presented to a referral practice with clinical signs of congestive heart failure. Diagnosis was confirmed with echocardiography. Treatment with torsemide as well as other cardiac medications was instituted. The cases were evaluated and monitored with physical examinations, clinicopathologic data, and repeat echocardiograms.

RESULTS

Torsemide (PO, q 12 h [median 0.5 mg/kg; IQR, 0.5 to 0.5 mg/kg; range, 0.25 to 1 mg/kg]) was well tolerated in the 12 cases. There were improvements in heart rate and respiratory rate and increases in plasma creatinine concentration (median, 1.3 vs 1.9 mg/dL) that followed therapeutic interventions that included torsemide. Median survival time of equids with CHF treated with torsemide was 189 days (IQR, 10 to 348.25 days; range, 2 to 806 days), with 2 distinct clusters. Four cases were euthanized within 2 weeks after starting treatment, while 8 survived longer than 137 days or are currently alive.

CLINICAL RELEVANCE

Torsemide can be used in equids diagnosed with CHF without serious adverse events and has the potential to be a useful oral diuretic. The nature of the study does not allow us to conclude that torsemide had a causal relationship with clinical progression.

Abstract

OBJECTIVE

Information about congestive heart failure (CHF) treatment in the horse is limited. Torsemide, an oral loop diuretic, is increasingly used in humans, dogs, and cats with CHF. Torsemide is well absorbed and induces diuresis in healthy horses, and its use in a horse with CHF has been reported. This retrospective descriptive study aimed to describe the use of torsemide in equids with CHF.

ANIMALS

12 equids (10 horses, 1 miniature donkey, and 1 mule).

CLINICAL PRESENTATION

Horses presented to a referral practice with clinical signs of congestive heart failure. Diagnosis was confirmed with echocardiography. Treatment with torsemide as well as other cardiac medications was instituted. The cases were evaluated and monitored with physical examinations, clinicopathologic data, and repeat echocardiograms.

RESULTS

Torsemide (PO, q 12 h [median 0.5 mg/kg; IQR, 0.5 to 0.5 mg/kg; range, 0.25 to 1 mg/kg]) was well tolerated in the 12 cases. There were improvements in heart rate and respiratory rate and increases in plasma creatinine concentration (median, 1.3 vs 1.9 mg/dL) that followed therapeutic interventions that included torsemide. Median survival time of equids with CHF treated with torsemide was 189 days (IQR, 10 to 348.25 days; range, 2 to 806 days), with 2 distinct clusters. Four cases were euthanized within 2 weeks after starting treatment, while 8 survived longer than 137 days or are currently alive.

CLINICAL RELEVANCE

Torsemide can be used in equids diagnosed with CHF without serious adverse events and has the potential to be a useful oral diuretic. The nature of the study does not allow us to conclude that torsemide had a causal relationship with clinical progression.

Supplementary Materials

    • Supplementary Table S1 (PDF 108 KB)
    • Supplementary Table S2 (PDF 117 KB)
    • Supplementary Table S3 (PDF 107 KB)
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