Opioids Do Not Effectively Treat Breathlessness in Heart Failure

Using opioids to treat breathlessness in heart failure (HF) had little efficacy, and opioid use increased risk for several adverse events, according to a systematic review and meta-analysis published in the journal Heart .

Although opioids are recommended to treat breathlessness in patients with advanced heart failure, meta-analyses to support these recommendations have been lacking. Investigators from Germany and Switzerland therefore conducted a systematic review and meta-analysis to assess the effects of opioids on breathlessness in patients with advanced HF.

The investigators searched publication databases through July 2021 for randomized controlled trials evaluating the use of opioids in HF. A total of 8 trials published between 1997 and 2020 were included in this analysis. Most trials had cross-over designs (n=7). The pooled sample size was 271 patients.

The researchers found no significant difference in treatment effect (standardized mean difference [SMD], 0.03; 95% CI, -0.21 to 0.28; I², 0%) when breathlessness was treated with opioids (n=151 patients) vs placebo (n=120 patients).

Quality of life, a secondary outcome of interest in the meta-analysis, was reported on by 4 studies. Here, too, investigators found no significant differences in patients treated with opioids vs control group patients.

With respect to adverse events, opioids were not associated with increased risk for nausea (risk ratio [RR], 3.13; 95% CI, 0.70-14.07; I², 7%) or respiratory rate changes (mean difference [MD], 0.25; 95% CI, -1.22 to 0.72 breaths/minute). However, opioid use vs placebo was more strongly associated with constipation (RR, 4.77; 95% CI, 1.98-11.53; I², 0%), vomiting (RR, 4.29; 95% CI, 1.15-16.01; I², 0%), changes to heart rate (MD, -4.90; 95% CI, -8.90 to -0.90 bpm), and changes in arterial oxygen saturation (MD, -0.92%; 95% CI, -1.79% to -0.06%).

The major limitation of this analysis was the small number of studies and the small sample size.

Overall, said study authors, these data did not support the use of opioids in the setting of HF. “This systematic review questions the benefits of opioids for the treatment of breathlessness in patients with HF. We suggest that opioids may only be the very last option if all options have failed or in case of an emergency,” the investigators concluded.