TY - JOUR
T1 - Clinical outcomes of opioid administration in acute and chronic heart failure
T2 - A meta-analysis
AU - Pratama, Nando Reza
AU - Anastasia, Elsha Stephanie
AU - Wardhani, Nabila Putri
AU - Budi, David Setyo
AU - Wafa, Ifan Ali
AU - Susilo, Hendri
AU - Alsagaff, Mochamad Yusuf
AU - Wungu, Citrawati Dyah Kencono
AU - Sutanto, Henry
AU - Oceandy, Delvac
N1 - Funding Information:
This meta-analysis included retrospective and prospective cohort studies and randomized controlled trials (RCTs). The titles and abstracts of all retrieved studies were screened based on the following eligibility criteria: studies (1) involving patients with AHF (i.e., patients with rapid or gradual onset of symptoms leading to hospitalization or an emergency department visit and those with clinical manifestations (first onset or de novo) including acute decompensation, acute pulmonary edema, isolated right ventricular failure, and cardiogenic shock) or CHF (i.e., patients who have established HF and are stable and those with gradual onset of symptoms not requiring hospitalization); (2) involving adults (≥18 years); (3) involving patients receiving opioids (e.g., morphine); (4) comparing an intervention group with a control group (i.e., standard therapy, placebo, or none); and (5) that reported at least one of our outcomes of interest. Clinical outcomes of AHF and CHF were analyzed separately. For AHF, our primary endpoints included mortality, ventilatory support, and intensive care unit (ICU) admission, while our secondary endpoints included hospital readmission, length of hospitalization, inotrope use, and breathlessness score. For CHF, our primary endpoint was breathlessness score, and our secondary endpoints were the minute ventilation/end-tidal carbon dioxide production (VE-VCO2) slope (as an indicator of ventilatory efficiency) and the exercise test duration. Review articles, irrelevant studies, studies not involving human subjects, and duplicates were excluded.For AHF, mortality (all-cause, in-hospital, 7-day, and 30-day mortality), ventilatory support (i.e., invasive and noninvasive ventilation), and ICU admission were the primary endpoints. The secondary endpoints were hospital readmission, length of hospitalization, inotrope use, and the breathlessness score.In AHF, our meta-analysis revealed that opioid use increased the risk for requiring ventilatory support, ICU admission, and the use of inotropes. The overall mortality outcome was insignificant because of the high heterogeneity caused by the study by Peacock et al. [35]; however, the result of the study by Peacock et al. is consistent with the effect estimates of our meta-analysis.
Publisher Copyright:
© 2022 The Authors
PY - 2022/10
Y1 - 2022/10
N2 - Background and aims: Opioid use in heart failure (HF) management is controversial, and whether rapid symptomatic relief outweighs the risks of opioid use in HF remains unknown. This study aimed to explore the clinical outcomes of opioid administration in patients with acute or chronic HF. Methods: A systematic search for eligible studies was conducted in databases (MEDLINE, Scopus, Web of Science, EBSCO) and registries (ClinicalTrials.gov, WHO Clinical Trial Registry) until June 8, 2022. Odds ratios (ORs) or adjusted OR (aORs) and mean difference (MD) or standardized MD were quantified for binary and continuous outcomes, respectively. Meta-regression was performed using the restricted maximum likelihood method. Results: A total of 20 studies (154,736 participants) were included. In acute HF, opioid use presented a high risk for in-hospital mortality (OR = 2.35; 95% confidence interval (CI): 1.03–5.38; I2 = 97%), invasive (OR = 2.78; 95%CI: 1.17–6.61; I2 = 93%) and noninvasive (OR = 2.97; 95%CI: 1.06–8.28; I2 = 95%) ventilations, intensive care unit admission (OR = 3.62; 95%CI: 3.11–4.21; I2 = 6%), and inotrope use (OR = 2.54; 95%CI: 1.94–3.32; I2 = 63%). In chronic HF New York Heart Association (NYHA) Class II/III, opioid use improved ventilatory efficiency (MD = −3.16; 95%CI: (−4.78)–(−1.54); I2 = 0%), and exercise test duration (MD = 69.24; 95%CI: 10.11–128.37; I2 = 89%). Conclusions: Opioids are not recommended for acute HF management; however, they showed an advantage in exercise testing by improving ventilatory efficiency, chemosensitivity, and exercise test duration in stable patients with chronic HF NYHA Class II/III. Nonetheless, larger randomized controlled trials and individual patient-level data meta-analyses are warranted.
AB - Background and aims: Opioid use in heart failure (HF) management is controversial, and whether rapid symptomatic relief outweighs the risks of opioid use in HF remains unknown. This study aimed to explore the clinical outcomes of opioid administration in patients with acute or chronic HF. Methods: A systematic search for eligible studies was conducted in databases (MEDLINE, Scopus, Web of Science, EBSCO) and registries (ClinicalTrials.gov, WHO Clinical Trial Registry) until June 8, 2022. Odds ratios (ORs) or adjusted OR (aORs) and mean difference (MD) or standardized MD were quantified for binary and continuous outcomes, respectively. Meta-regression was performed using the restricted maximum likelihood method. Results: A total of 20 studies (154,736 participants) were included. In acute HF, opioid use presented a high risk for in-hospital mortality (OR = 2.35; 95% confidence interval (CI): 1.03–5.38; I2 = 97%), invasive (OR = 2.78; 95%CI: 1.17–6.61; I2 = 93%) and noninvasive (OR = 2.97; 95%CI: 1.06–8.28; I2 = 95%) ventilations, intensive care unit admission (OR = 3.62; 95%CI: 3.11–4.21; I2 = 6%), and inotrope use (OR = 2.54; 95%CI: 1.94–3.32; I2 = 63%). In chronic HF New York Heart Association (NYHA) Class II/III, opioid use improved ventilatory efficiency (MD = −3.16; 95%CI: (−4.78)–(−1.54); I2 = 0%), and exercise test duration (MD = 69.24; 95%CI: 10.11–128.37; I2 = 89%). Conclusions: Opioids are not recommended for acute HF management; however, they showed an advantage in exercise testing by improving ventilatory efficiency, chemosensitivity, and exercise test duration in stable patients with chronic HF NYHA Class II/III. Nonetheless, larger randomized controlled trials and individual patient-level data meta-analyses are warranted.
KW - Cardiovascular disease
KW - Heart failure
KW - Meta-analysis
KW - Morphine
KW - Opioid
UR - http://www.scopus.com/inward/record.url?scp=85140034265&partnerID=8YFLogxK
U2 - 10.1016/j.dsx.2022.102636
DO - 10.1016/j.dsx.2022.102636
M3 - Review article
C2 - 36240686
AN - SCOPUS:85140034265
SN - 1871-4021
VL - 16
JO - Diabetes and Metabolic Syndrome: Clinical Research and Reviews
JF - Diabetes and Metabolic Syndrome: Clinical Research and Reviews
IS - 10
M1 - 102636
ER -
