{"id":"472fce716fe2","type":"article","url":"https://hartvaat.nl/2023/06/26/opioiden-bij-dyspneu-en-hartfalen-meta-analyse-toont-geen-voordeel/","title":"Opioïden bij dyspneu en hartfalen: meta-analyse toont geen voordeel","title_en":"Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","alcoholgebruik","bisoprolol","carvedilol","empagliflozine","nt-probnp"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-322074","source_url":"https://doi.org/10.1136/heartjnl-2022-322074","authors":["Jan Gaertner","Tanja Fusi-Schmidhauser","Stephanie Stock","Waldemar Siemens","Vera Vennedey"],"significance":7,"published":"2023-06-26","source_date":"2023-06-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/digoxine-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This meta-analysis found that opioids do not significantly improve breathlessness in heart failure despite their widespread use, challenging the traditional practice of opioid administration for dyspnea in acute heart failure.","created":"2026-07-03T10:30:26Z","updated":"2026-07-03T18:39:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse toonden dat opioïden bij hartfalen-gerelateerde dyspneu geen significant symptoomvoordeel bieden bij aanzienlijke bijwerkingen. Dit ondermijnt het gangbare leerboekadvies om morfine bij acuut hartfalen te gebruiken.","abstract_original":"BACKGROUND: For the treatment of breathlessness in heart failure (HF), most textbooks advocate the use of opioids. Yet, meta-analyses are lacking. METHODS: A systematic review was performed for randomised controlled trials (RCTs) assessing effects of opioids on breathlessness (primary outcome) in patients with HF. Key secondary outcomes were quality of life (QoL), mortality and adverse effects. Cochrane Central Register of Controlled Trials, MEDLINE and Embase were searched in July 2021. Risk of bias (RoB) and certainty of evidence were assessed by the Cochrane RoB 2 Tool and Grading of Recommendations Assessment, Development and Evaluation criteria, respectively. The random-effects model was used as primary analysis in all meta-analyses. RESULTS: After removal of duplicates, 1180 records were screened. We identified eight RCTs with 271 randomised patients. Seven RCTs could be included in the meta-analysis for the primary endpoint breathlessness with a standardised mean difference of 0.03 (95% CI -0.21 to 0.28). No study found statistically significant differences between the intervention and placebo. Several key secondary outcomes favoured placebo: risk ratio of 3.13 (95% CI 0.70 to 14.07) for nausea, 4.29 (95% CI 1.15 to 16.01) for vomiting, 4.77 (95% CI 1.98 to 11.53) for constipation and 4.42 (95% CI 0.79 to 24.87) for study withdrawal. All meta-analyses revealed low heterogeneity (I2 in all these meta-analyses was <8%). CONCLUSION: Opioids for treating breathlessness in HF are questionable and may only be the very last option if other options have failed or in case of an emergency. PROSPERO REGISTRATION NUMBER: CRD42021252201."}