Expanding perspective: considering opioids in the management of dyspnoea in end-stage heart failure

Correspondence to Dr Jill M Steiner, Cardiology, University of Washington Medical Center, Seattle, WA 98195, USA; jills8@cardiology.washington.edu Heart failure is a chronic and progressive disease often accompanied by burdensome symptoms that limit quality of life. Over two-thirds of patients with end-stage heart failure experience dyspnoea.1 The experience of breathlessness can be terrifying for patients and is a major contributor to psychological distress in this population.2 Opioids are therefore a standard part of dyspnoea management at the end of life in an attempt to decrease the experience of air hunger. For patients with heart failure to be considered nearing end of life and hospice eligible (prognosis of less than 6 months), they must have class IV symptoms, indicating the presence of symptoms at rest and discomfort with any physical activity.