BACKGROUND: The longer-term effects of opioids for breathlessness are not known in people with chronic heart failure (CHF). OBJECTIVE: Our aim was to assess the longer-term effect of oral opioids on breathlessness due to CHF. METHODS: We conducted a 3-month open-label extension to a crossover randomized controlled trial (RCT) comparing 4 days of morphine, oxycodone, and placebo. Thirty-five participants from a tertiary cardiology clinic completed the RCT. Thirty-three were followed for 3 months, continuing open-label opioids if they wished. Thirteen participants continued an opioid; 20 did not. Four measures of breathlessness intensity (0-10 numerical rating scale [NRS] and modified Borg score, each recording worst and average breathlessness during 24 hours) were combined using principal component analysis to give a single measure for the primary analysis. Groups were compared using analysis of covariance. Secondary measures included quality of life (SF-12(®) Health Survey), cardiorespiratory, and global impression of change in breathlessness at 3 months. RESULTS: At 3 months, the composite breathlessness measure improved to a greater extent in the opioid group (p=0.017). The opioid group had an improvement in global impression of change (mean 2.62 [opioids] versus -0.65 [nonopioids]; p=0.0009). The SF-12 physical component improved more in the opioid group (p=0.014). Cardiorespiratory variables were unchanged. CONCLUSIONS:Opioids given for 3 months were well tolerated and safe. Opioid-related improvement in breathlessness in people with CHF might not be seen until longer-term administration. We cannot conclude from these data that they are effective and a longer-term RCT is needed.
RCT Entities:
BACKGROUND: The longer-term effects of opioids for breathlessness are not known in people with chronic heart failure (CHF). OBJECTIVE: Our aim was to assess the longer-term effect of oral opioids on breathlessness due to CHF. METHODS: We conducted a 3-month open-label extension to a crossover randomized controlled trial (RCT) comparing 4 days of morphine, oxycodone, and placebo. Thirty-five participants from a tertiary cardiology clinic completed the RCT. Thirty-three were followed for 3 months, continuing open-label opioids if they wished. Thirteen participants continued an opioid; 20 did not. Four measures of breathlessness intensity (0-10 numerical rating scale [NRS] and modified Borg score, each recording worst and average breathlessness during 24 hours) were combined using principal component analysis to give a single measure for the primary analysis. Groups were compared using analysis of covariance. Secondary measures included quality of life (SF-12(®) Health Survey), cardiorespiratory, and global impression of change in breathlessness at 3 months. RESULTS: At 3 months, the composite breathlessness measure improved to a greater extent in the opioid group (p=0.017). The opioid group had an improvement in global impression of change (mean 2.62 [opioids] versus -0.65 [nonopioids]; p=0.0009). The SF-12 physical component improved more in the opioid group (p=0.014). Cardiorespiratory variables were unchanged. CONCLUSIONS: Opioids given for 3 months were well tolerated and safe. Opioid-related improvement in breathlessness in people with CHF might not be seen until longer-term administration. We cannot conclude from these data that they are effective and a longer-term RCT is needed.
Authors: Anja Hayen; Vishvarani Wanigasekera; Olivia K Faull; Stewart F Campbell; Payashi S Garry; Simon J M Raby; Josephine Robertson; Ruth Webster; Richard G Wise; Mari Herigstad; Kyle T S Pattinson Journal: Neuroimage Date: 2017-01-03 Impact factor: 6.556
Authors: Lourdes Vicent; Juan Manuel Nuñez Olarte; Luis Puente-Maestu; Esther Artajona; Francisco Fernández-Avilés; Manuel Martínez-Sellés Journal: J Geriatr Cardiol Date: 2016-07 Impact factor: 3.327
Authors: Miriam J Johnson; Sarah Cockayne; David C Currow; Kerry Bell; Kate Hicks; Caroline Fairhurst; Rhian Gabe; David Torgerson; Laura Jefferson; Stephen Oxberry; Justin Ghosh; Karen J Hogg; Jeremy Murphy; Victoria Allgar; John G F Cleland; Andrew L Clark Journal: ESC Heart Fail Date: 2019-08-06