Opioid Use for Dyspnoea in Advanced Heart Failure

PURPOSE OF REVIEW: This narrative review aims to provide an overview of the available evidence on opioid use for refractory dyspnoea in advanced heart failure, focusing on mechanisms, effectiveness, safety, patient selection, and their possible role within a palliative care approach. Evidence from clinical trials and observational studies is presented and practical recommendations about opioid use in patients with refractory dyspnoea in advanced heart failure are provided. RECENT FINDINGS: Dyspnoea in advanced heart failure is a multidimensional symptom that may persist despite optimal medical therapy. Randomised trials have shown mixed and limited benefits for chronic dyspnoea, while observational studies suggest that opioids can provide clinically relevant short-term relief of refractory dyspnoea in advanced heart failure, with an overall manageable safety profile. In contrast, opioid use in acute heart failure has been associated with worse outcomes. Despite mixed and limited evidence, opioids may be considered for symptom relief in selected patients with advanced heart failure and chronic refractory dyspnoea when used cautiously. Their use should be individualized based on individual patients' characteristics. Opioid use should be avoided in acute heart failure management. Further research is needed to better define patient selection and optimal use.