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Short-term opioids for breathlessness in stable chronic heart failure: A randomized controlled trial

Oxberry, Stephen G.; Torgerson, David J.; Bland, J. Martin; Clark, Andrew L.; Cleland, John G. F.; Johnson, Miriam J.

Authors

Stephen G. Oxberry

David J. Torgerson

J. Martin Bland

Andrew L. Clark

John G. F. Cleland



Abstract

Aims To assess the effect of oral opioids vs. placebo on breathlessness in patients with chronic heart failure (CHF). Methods and results Oral morphine (Oramorph), oral oxycodone (Oxynorm), and placebo were studied in an outpatient setting. Once randomized, participants received all three interventions in a controlled double-blind crossover trial for 4 days each, with a 3-day washout between interventions. Patients known to the Hull and East Yorkshire Academic Cardiology department with CHF (New York Heart Association Grade III–IV) were invited to participate. Participants were eligible if they were on standard medical therapy with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and diuretics. Participant-rated change in 11-point numerical rating scale (NRS) (average over previous 24 h) breathlessness severity score from baseline (Day 1) to Day 4 of treatment was the primary outcome measure. The study was powered to detect a one-point change in severity.Thirty-nine patients were randomized and 35 completed all three study arms. Breathlessness severity was reduced from baseline with all three interventions. There was no statistically significant difference between active intervention and placebo or between the two types of opioid for the primary endpoint [-1.37 in NRS score for placebo group vs. -0.41 in morphine group (P = 0.13) and -1.29 for oxycodone group (P = 0.90)]. The response to treatment was not affected by aetiology, severity of CHF, or concurrent drug therapy. Opioid administration did not cause detrimental changes in clinical observations and was well tolerated. Conclusion We demonstrated no benefit over placebo for the relief of breathlessness with short-term low-dose oral opioids for CHF patients.

Citation

Oxberry, S. G., Torgerson, D. J., Bland, J. M., Clark, A. L., Cleland, J. G. F., & Johnson, M. J. (2011). Short-term opioids for breathlessness in stable chronic heart failure: A randomized controlled trial. European journal of heart failure, 13(9), 1006-1012. https://doi.org/10.1093/eurjhf/hfr068

Journal Article Type Article
Acceptance Date Apr 15, 2011
Online Publication Date Feb 18, 2014
Publication Date Sep 1, 2011
Deposit Date Nov 13, 2014
Publicly Available Date Mar 29, 2024
Journal European Journal Of Heart Failure
Print ISSN 1388-9842
Electronic ISSN 1879-0844
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 13
Issue 9
Pages 1006-1012
DOI https://doi.org/10.1093/eurjhf/hfr068
Keywords Cardiology and Cardiovascular Medicine
Public URL https://hull-repository.worktribe.com/output/467377