OBJECTIVES: The purpose of this study was to test the hypothesis that patients with evidence of left-systolic ventricular dysfunction treated with torsemide would have fewer hospitalizations for heart failure, improved disease-specific quality of life, and lower direct inpatient costs compared to patients treated with furosemide. Pharmacokinetic studies have shown that the bioavailability of torsemide is more complete and predictable than furosemide, especially in patients with heart failure. METHODS: Prospective, randomized trial. This is an interim analysis of 191 hospitalized patients (65 years of age ? 12 SD) prescribed torsemide (n=93) or furosemide (n=98) for one year. Data were analyzed at 15 months as part of a planned interim intention to treat analysis. Duration of follow-up did not differ between treatment groups (233 days ? 134 SD). Dependent variables were the numbers of subsequent hospitalizations for heart failure, other cardiovascular causes, and all causes, their corresponding count of hospital days, and direct costs. Disease-specific quality of life was measured using the Chronic Heart Failure Questionnaire. RESULTS: Patients treated with torsemide had significantly fewer hospitalizations for heart failure (11 vs. 28)* and other cardiovascular causes (20 vs. 48) *. The difference in all cause hospitalizations was not significant (77 vs. 107). Hospital days were significantly less for patients treated with torsemide for all cardiovascular causes only (91 vs. 222) *. Dyspnea, fatigue, and total disease-specific quality of life were significantly better for patients treated with torsemide. Direct inpatient costs for all cause hospitalizations were $793,460 ($8,532 per patient) for torsemide and $1,161,617 ($11,617 per patient) for furosemide*. CONCLUSIONS: Patients treated with torsemide have fewer hospitalizations for heart failure and other cardiovascular causes, improved dyspnea and fatigue, and lower direct inpatient health care costs. These effects are presumably due to the complete and reliable absorption of torsemide.