Opioids to be used as last option to control dyspnea in heart failure events

Written By : Jacinthlyn Sylvia |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-03-14T10:15:42+05:30 | Updated On 14 March 2023 3:12 PM IST

A new study published in Heart suggests that opioids may only be used as a very last resort in the event that all other methods have failed or in an emergency to treat dyspnea in heart failure (HF).

The majority of textbooks recommend the use of opioids to treat dyspnea caused by heart failure. Meta-analyses are sparse, nevertheless. So, this study was carried out by Jan Gaertner and colleagues to analyze the efficiency of opioids in treating dyspnea in heart failure patients as well as their negative effects.

Randomized controlled trials (RCTs) evaluating the effects of opioids on breathlessness (the primary outcome) in patients with HF were the subject of a systematic review. Quality of life (QoL), death, and adverse effects were significant secondary outcomes. In July 2021, searches were conducted on the Cochrane Central Registry of Controlled Trials, MEDLINE, and Embase. The Cochrane RoB 2 Tool and the Grading of Recommendations Assessment, Development and Evaluation criteria were used, respectively, to evaluate the risk of bias (RoB) and the certainty of the evidence. In all meta-analyses, the random-effects model served as the major analytical tool.

The key findings of this study were:

1180 records were checked after duplicates were removed.

Eight RCTs with 271 randomly assigned patients were found. For the primary endpoint of breathlessness, seven RCTs with a standardized mean difference of 0.03 (95% CI 0.21 to 0.28), could be included in the meta-analysis.

No investigation discovered significant variations between the treatments and placebo. The risk ratio for nausea was 3.13 (95% CI 0.70 to 14.07), the risk ratio for vomiting was 4.29 (95% CI 1.15 to 16.01), the risk ratio for constipation was 4.77 (95% CI 1.98 to 11.53), and the risk ratio for study withdrawal was 4.42 (95% CI 0.79 to 24.87).

Little heterogeneity was found in all of the meta-analyses (I2 in all of these meta-analyses was 8%).

In conclusion, the authors advise that opioids should only be used as a last option or in urgent cases when all other therapies have failed.

Reference:

Gaertner, J., Fusi-Schmidhauser, T., Stock, S., Siemens, W., & Vennedey, V. (2023). Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis. Heart (British Cardiac Society). https://doi.org/10.1136/heartjnl-2022-322074

heart failureHeart JournalOpioid intake

Source : British Cardiac Society

Jacinthlyn Sylvia

Neuroscience Masters graduate

Jacinthlyn Sylvia, a Neuroscience Master's graduate from Chennai has worked extensively in deciphering the neurobiology of cognition and motor control in aging. She also has spread-out exposure to Neurosurgery from her Bachelor’s. She is currently involved in active Neuro-Oncology research. She is an upcoming neuroscientist with a fiery passion for writing. Her news cover at Medical Dialogues feature recent discoveries and updates from the healthcare and biomedical research fields. She can be reached at editorial@medicaldialogues.in

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751