{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T14:47:38Z","timestamp":1766760458505,"version":"3.41.2"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>Aims:<\/jats:title>\n            <jats:p>The impact of opioids in acute heart failure (AHF) is unclear. This systematic review with meta-analysis aimed to evaluate the mortality risk associated with opioid use in AHF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>An electronic search was performed in MEDLINE, CENTRAL, Web of Science Core Collection, and SCIELO (December 2019) for randomized controlled trials and observational studies evaluating the impact of opioids in in-hospital and 30-day mortality in patients with AHF. Data were screened, extracted, and appraised by 2 independent reviewers. A random-effects meta-analysis to estimate the pooled odds ratios (OR) with 95% confidence intervals (CI) was performed and heterogeneity was evaluated using the I<jats:sup>2<\/jats:sup> statistics. Six observational retrospective studies with 151,735 participants were included. Pooled results showed a statistical significant association between morphine and in-hospital mortality (OR 1.78; 95% CI 1.01\u20133.13; I<jats:sup>2<\/jats:sup> = 92%; 6 studies) and 30-day mortality (OR 1.56; 95% CI 1.14\u20132.15; I<jats:sup>2<\/jats:sup> = 0; 2 studies). Both outcomes were rated as having a serious risk of bias and had a very low Grading of Recommendation, Assessment, Development, and Evaluation evidence.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Opioids seem to be associated with an increased risk of short-term mortality in AHF patients; however, the confidence in the estimated effect is very low, which highlights the need of further research to evaluate this question.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/fjc.0000000000000954","type":"journal-article","created":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T18:51:54Z","timestamp":1606243914000},"page":"123-129","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["The Risk of Mortality Associated With Opioid Use in Patients With Acute Heart Failure: Systematic Review and Meta-analysis"],"prefix":"10.1097","volume":"77","author":[{"given":"Daniel","family":"Gao","sequence":"first","affiliation":[{"name":"Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;"}]},{"given":"Cl\u00e1udio","family":"David","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;"},{"name":"Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;"},{"name":"Centro Cardiovascular da Universidade de Lisboa\u2014CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; and"},{"name":"Servi\u00e7o de Cardiologia, Departamento do Cora\u00e7\u00e3o e Vasos; Hospital Universit\u00e1rio de Santa Maria\u2014CHULN, Lisbon, Portugal."}]},{"given":"M\u00e1rio M.","family":"Rosa","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;"},{"name":"Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;"}]},{"given":"Jo\u00e3o","family":"Costa","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;"},{"name":"Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;"}]},{"given":"Fausto J.","family":"Pinto","sequence":"additional","affiliation":[{"name":"Centro Cardiovascular da Universidade de Lisboa\u2014CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; and"},{"name":"Servi\u00e7o de Cardiologia, Departamento do Cora\u00e7\u00e3o e Vasos; Hospital Universit\u00e1rio de Santa Maria\u2014CHULN, Lisbon, Portugal."}]},{"given":"Daniel","family":"Caldeira","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal;"},{"name":"Centro Cardiovascular da Universidade de Lisboa\u2014CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; and"},{"name":"Servi\u00e7o de Cardiologia, Departamento do Cora\u00e7\u00e3o e Vasos; Hospital Universit\u00e1rio de Santa Maria\u2014CHULN, Lisbon, Portugal."}]}],"member":"276","published-online":{"date-parts":[[2021,2]]},"reference":[{"key":"R1-20250802","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1002\/cce2.61","article-title":"Acute heart failure: epidemiology and socioeconomic burden","volume":"3","author":"Farmakis","year":"2017","journal-title":"Contin Cardiol Educ."},{"key":"R2-20250802","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1002\/ehf2.12092","article-title":"Acute heart failure facts and numbers: acute heart failure populations","volume":"3","author":"Searle","year":"2016","journal-title":"ESC Hear Fail."},{"key":"R3-20250802","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ahj.2004.08.005","article-title":"Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE)","volume":"149","author":"Adams","year":"2005","journal-title":"Am Heart J."},{"issue":"suppl 1","key":"R4-20250802","doi-asserted-by":"crossref","first-page":"G11","DOI":"10.1093\/eurheartj\/suw044","article-title":"Understanding acute heart failure: pathophysiology and diagnosis","volume":"18","author":"Arrigo","year":"2016","journal-title":"Eur Hear J Suppl."},{"key":"R5-20250802","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s11897-017-0351-y","article-title":"Acute heart failure: definition, classification and epidemiology","volume":"14","author":"Kurmani","year":"2017","journal-title":"Curr Heart Fail Rep."},{"key":"R6-20250802","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.jacc.2013.11.053","article-title":"The global health and economic burden of hospitalizations for heart failure lessons learned from hospitalized heart failure registries","volume":"63","author":"Chioncel","year":"2014","journal-title":"J Am Coll Cardiol."},{"key":"R7-20250802","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/0002-9343(78)90707-6","article-title":"Hospital treatment of congestive heart failure. 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