Clinical outcomes of opioid administration in acute and chronic heart failure: A meta-analysis

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.

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.

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%).

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.