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Meta-Analysis
. 2023 Jun 26;109(14):1064-1071.
doi: 10.1136/heartjnl-2022-322074.

Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis

Jan Gaertner  1   2 , Tanja Fusi-Schmidhauser  3   4 , Stephanie Stock  5 , Waldemar Siemens #  6   7 , Vera Vennedey #  5
Affiliations
Meta-Analysis

Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis

Jan Gaertner et al. Heart. .

Abstract

Background: For the treatment of breathlessness in heart failure (HF), most textbooks advocate the use of opioids. Yet, meta-analyses are lacking.

Methods: A systematic review was performed for randomised controlled trials (RCTs) assessing effects of opioids on breathlessness (primary outcome) in patients with HF. Key secondary outcomes were quality of life (QoL), mortality and adverse effects. Cochrane Central Register of Controlled Trials, MEDLINE and Embase were searched in July 2021. Risk of bias (RoB) and certainty of evidence were assessed by the Cochrane RoB 2 Tool and Grading of Recommendations Assessment, Development and Evaluation criteria, respectively. The random-effects model was used as primary analysis in all meta-analyses.

Results: After removal of duplicates, 1180 records were screened. We identified eight RCTs with 271 randomised patients. Seven RCTs could be included in the meta-analysis for the primary endpoint breathlessness with a standardised mean difference of 0.03 (95% CI -0.21 to 0.28). No study found statistically significant differences between the intervention and placebo. Several key secondary outcomes favoured placebo: risk ratio of 3.13 (95% CI 0.70 to 14.07) for nausea, 4.29 (95% CI 1.15 to 16.01) for vomiting, 4.77 (95% CI 1.98 to 11.53) for constipation and 4.42 (95% CI 0.79 to 24.87) for study withdrawal. All meta-analyses revealed low heterogeneity (I2 in all these meta-analyses was <8%).

Conclusion: Opioids for treating breathlessness in HF are questionable and may only be the very last option if other options have failed or in case of an emergency.

Prospero registration number: CRD42021252201.

Keywords: heart failure; palliative care.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study identification and selection process (PRISMA flowchart).
Figure 2
Figure 2
Risk of bias summary. *No additional bias (eg, unequal group allocation, insufficient period between treatments) identified in cross-over trials. Oxberry 2011: high risk for nausea, constipation, drowsiness, vomiting, dizziness, headache, abdominal pain, sweating, dry mouth; some concerns for breathlessness, heart rate, blood pressure, breathing rate, arterial oxygen saturation. Ferreira 2018: high risk for nausea and constipation; some concerns for breathlessness, respiratory rate, arterial oxygen satuation.
Figure 3
Figure 3
Forest plot with breathlessness as primary outcome. SMD, standardised mean difference.
Figure 4
Figure 4
Forest plot with nausea as secondary outcome.
Figure 5
Figure 5
Forest plot with vomiting as secondary outcome.
Figure 6
Figure 6
Forest plot with constipation as secondary outcome.
See this image and copyright information in PMC

Comment in

References

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