Faculty of Medicine, Universitas Airlangga, Indonesia.
Department of Cardiology and Vascular Medicine, Universitas Airlangga Hospital, Surabaya, Indonesia.
Diabetes Metab Syndr. 2022 Oct;16(10):102636. doi: 10.1016/j.dsx.2022.102636. Epub 2022 Oct 2.
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; I = 97%), invasive (OR = 2.78; 95%CI: 1.17-6.61; I = 93%) and noninvasive (OR = 2.97; 95%CI: 1.06-8.28; I = 95%) ventilations, intensive care unit admission (OR = 3.62; 95%CI: 3.11-4.21; I = 6%), and inotrope use (OR = 2.54; 95%CI: 1.94-3.32; I = 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); I = 0%), and exercise test duration (MD = 69.24; 95%CI: 10.11-128.37; I = 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.
在心力衰竭（HF）管理中使用阿片类药物存在争议，阿片类药物在 HF 中的使用是否能迅速缓解症状，而不带来风险仍不清楚。本研究旨在探讨急性或慢性 HF 患者使用阿片类药物的临床结局。
系统检索数据库（MEDLINE、Scopus、Web of Science、EBSCO）和注册处（ClinicalTrials.gov、WHO 临床试验注册处），直到 2022 年 6 月 8 日，以获取合格研究的相关信息。分别使用比值比（OR）或调整后的 OR（aOR）和均数差（MD）或标准化 MD 来量化二分类和连续结局的结果。使用限制最大似然法进行元回归分析。
共纳入 20 项研究（154736 名参与者）。在急性 HF 中，阿片类药物的使用与住院期间死亡率（OR=2.35；95%置信区间（CI）：1.03-5.38；I²=97%）、有创（OR=2.78；95%CI：1.17-6.61；I²=93%）和无创（OR=2.97；95%CI：1.06-8.28；I²=95%）通气、重症监护病房入院（OR=3.62；95%CI：3.11-4.21；I²=6%）和儿茶酚胺类药物的使用（OR=2.54；95%CI：1.94-3.32；I²=63%）相关。在慢性 HF 纽约心脏协会（NYHA）心功能 II/III 级患者中，阿片类药物的使用改善了通气效率（MD=-3.16；95%CI：-4.78--1.54；I²=0%）和运动试验持续时间（MD=69.24；95%CI：10.11-128.37；I²=89%）。
不建议在急性 HF 管理中使用阿片类药物；然而，在慢性 HF NYHA 心功能 II/III 级稳定患者中，阿片类药物在运动试验中显示出优势，可改善通气效率、化学敏感性和运动试验持续时间。然而，仍需要更大规模的随机对照试验和个体患者水平数据的荟萃分析。
