Effects of Dihydrocodeine on Chemosensitivity and Exercise Tolerance in Patients With Chronic Heart Failure

Chua, Tuan Peng; Harrington, Derek; Ponikowski, Piotr; Webb-Peploe, Katharine; Poole‐Wilson, Philip A.; Coats, Andrew J.S.

doi:10.1016/s0735-1097(96)00446-9

Cited by 131 publications

(103 citation statements)

References 34 publications

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“…Dihydrocodeine can reduce breathlessness and improve exercise tolerance in CHF, most likely by a reduction in chemosensitivity. 13 In the present study, dihydrocodeine administration caused a decrease in peripheral chemosensitivity (Ϫ40% versus placebo) with concomitant changes in the periodic respiratory pattern.…”

Section: Discussionmentioning

confidence: 45%

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Oscillatory Breathing Patterns During Wakefulness in Patients With Chronic Heart Failure

Anker²,

et al. 1999

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Background-Oscillatory breathing patterns characterized by rises and falls in ventilation with apnea (Cheyne-Stokes respiration [CSR]) or without apnea (periodic breathing [PB]) commonly occur during the daytime in chronic heart failure (CHF). We have prospectively characterized patients with cyclical breathing in terms of clinical characteristics, indices of autonomic control, prognosis, and the role of peripheral chemosensitivity. Methods and Results-To determine cyclical breathing pattern, power spectral analysis was applied to 30-minute recordings of respiration in 74 stable CHF patients. Analyses of heart rate variability and baroreflex sensitivity were used to assess autonomic balance. Peripheral chemosensitivity was assessed with the transient hypoxia method. We also determined whether the suppression of peripheral chemoreceptor activity (hyperoxia or dihydrocodeine) would influence the respiratory pattern. Cyclical respiration was found in 49 (66%) patients (22 [30%] CSR, 27 [36%] PB) and was associated with more advanced CHF symptoms, impaired autonomic balance, and increased chemosensitivity (0.80 and 0.75 versus 0.34 L ⅐ min Ϫ1 ⅐ %SaO 2 Ϫ1 , PϽ0.001, for CSR and PB versus normal breathing, respectively). Transient hyperoxia abolished oscillatory breathing in 7 of 8 patients. Dihydrocodeine administration decreased chemosensitivity by 42% (Pϭ0.05), which correlated with improvement in respiratory pattern. Cyclical breathing predicted poor 2-year survival (relative risk 9.41, PϽ0.01, by Cox proportional hazards analysis), independent of peak oxygen consumption (Pϭ0.04). Conclusions-An oscillatory breathing pattern during the daytime is a marker of impaired autonomic regulation and poor outcome. Augmented activity of peripheral chemoreceptors may be involved in the genesis of this respiratory pattern. Modulation of peripheral chemosensitivity can reduce or abolish abnormal respiratory patterns and may be an option in the management of CHF patients with oscillatory breathing. (Circulation. 1999;100:2418-2424.)

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Section: Discussionmentioning

confidence: 45%

“…13 Eight patients with a cyclical respiratory pattern received placebo or dihydrocodeine (1 mg/kg body wt) on 2 separate days in a randomized double-blind design.…”

Section: Effect Of Dihydrocodeine On Cyclical Respirationmentioning

confidence: 99%

Oscillatory Breathing Patterns During Wakefulness in Patients With Chronic Heart Failure

Anker²,

et al. 1999

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“…These findings suggest that at least in patients with preserved exercise capacity, an elevated ventilatory response to exercise may be related to abnormal reflex responses from the periphery. Further support for this mechanism comes from therapeutic studies that show that changes in the activity of chemoreceptors (with oxygen or opiates) 20 or muscle ergoreceptors (with exercise training) 10 can favorably affect the ventilatory response to exercise.…”

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confidence: 99%

Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Preserved Exercise Tolerance

et al. 2001

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Background-In patients with chronic heart failure (CHF) and preserved exercise tolerance, the value of cardiopulmonary exercise testing for risk stratification is not known. Elevated slope of ventilatory response to exercise (V E/V CO 2 ) predicts poor prognosis in advanced CHF. Derangement of cardiopulmonary reflexes may trigger exercise hyperpnea. We assessed the relationship between cardiopulmonary reflexes and V E/V CO 2 and investigated the prognostic value of V E/V CO 2 in CHF patients with preserved exercise tolerance. Methods and Results-Among 344 consecutive CHF patients, we identified 123 with preserved exercise capacity, defined as a peak oxygen consumption (peak V O 2 ) Ն18 mL · kg Ϫ1 · min Ϫ1 (age 56 years; left ventricular ejection fraction 28%; peak V O 2 23.5 mL · kg Ϫ1 · min Ϫ1 ). Hypoxic and hypercapnic chemosensitivity (nϭ38), heart rate variability (nϭ34), baroreflex sensitivity (nϭ20), and ergoreflex activity (nϭ20) were also assessed. We identified 40 patients (33%) with high V E/V CO 2 (ie, Ͼ34.0). During follow-up (49Ϯ22 months, Ͼ3 years in all survivors), 34 patients died (3-year survival 81%). High V E/V CO 2 (hazard ratio 4.3, PϽ0.0001) but not peak V O 2 (Pϭ0.7) predicted mortality. In patients with high V E/V CO 2 , 3-year survival was 57%, compared with 93% in patients with normal V E/V CO 2 (PϽ0.0001). Patients with high V E/V CO 2 demonstrated impaired reflex control, as evidenced by augmented peripheral (Pϭ0.01) and central (Pϭ0.0006) chemosensitivity, depressed low-frequency component of heart rate variability (PϽ0.0001) and baroreflex sensitivity (Pϭ0.03), and overactive ergoreceptors (Pϭ0.003) compared with patients with normal V E/V CO 2 . Conclusions-In CHF patients with preserved exercise capacity, enhanced ventilatory response to exercise is a simple marker of a widespread derangement of cardiovascular reflex control; it predicts poor prognosis, which peak V O 2 does not. (Circulation. 2001;103:967-972.)

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“…Small studies found that opioids are safe and effective for treatment of dyspnea in advanced HF patients 224 and reduce dyspnea and fatigue in patients with NYHA functional class II HF. 225 Paroxetine is effective for management of depression. 226 Thigh muscle strengthening is effective at reducing dyspnea and fatigue.…”

Section: End-of-life Carementioning

confidence: 99%

Heart Failure Management in Skilled Nursing Facilities

Jurgens¹,

Goodlin²,

Dolansky³

et al. 2015

Circ: Heart Failure

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655H eart failure (HF) is a complex syndrome in which structural or functional cardiac abnormalities impair the filling of ventricles or left ventricular ejection of blood. HF disproportionately occurs in those ≥65 years of age.1 Among the estimated 1.5 to 2 million residents in skilled nursing facilities (SNFs) in the United States, cardiovascular disease is the largest diagnostic category, and HF is common. 2,3Despite the high prevalence of HF in SNF residents, none of the large randomized clinical trials of HF therapy included SNF residents, and very few included patients >80 years of age with complex comorbidities.Several issues make it important to address HF care in SNFs. The healthcare environment and characteristics of SNF residents are distinct from those of community-dwelling adults. Comorbid illness unrelated to HF (eg, dementia, hip fracture) increases with age >75 years, and these conditions may complicate both the initial HF diagnosis and ongoing management. [4][5][6] Morbidity and mortality rates are significantly increased for hospitalized older adults with HF discharged to SNFs compared with those discharged to other sites. 7Transitions between hospitals and SNFs may be problematic. 8SNF 30-day rehospitalization rates for HF range from 27% to 43%, 7,9,10 and long-term care residents sent to the emergency department are at increased risk for hospital admission and death.11 The purpose of this scientific statement is to provide guidance for management of HF in SNFs to improve patientcentered outcomes and reduce hospitalizations. This statement addresses unique issues of SNF care and adapts HF guidelines and other recommendations to this setting. MethodsThis scientific statement on HF management in SNFs was developed by a writing group of experts representing nursing, medicine (cardiology, geriatrics, nursing home physicians, and palliative medicine), pharmacology, physical therapy, dietary clinical management, research, and quality of care. Sponsors (the American Heart Association [AHA] and the Heart Failure Society of America) identified specific members of the writing group, and others were selected on the basis of known expertise. A literature search was performed using the key The current document is solely the responsibility of the authors and does not represent the official views of the National Heart, Lung, and Blood Institute or the Department of Health and Human Services.The American Heart Association and the Heart Failure Society of America make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This document was approved by the American Heart Association Science Advisory and Coordinating Committee on September 15, 2014, and by the...

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Effects of Dihydrocodeine on Chemosensitivity and Exercise Tolerance in Patients With Chronic Heart Failure

Cited by 131 publications

References 34 publications

Oscillatory Breathing Patterns During Wakefulness in Patients With Chronic Heart Failure

Oscillatory Breathing Patterns During Wakefulness in Patients With Chronic Heart Failure

Enhanced Ventilatory Response to Exercise in Patients With Chronic Heart Failure and Preserved Exercise Tolerance

Heart Failure Management in Skilled Nursing Facilities

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