The management of dyspnoea in chronic heart failure
Abstract
PURPOSE OF REVIEW: To identify current management options for dyspnoeic people with chronic heart failure (CHF). RECENT FINDINGS: Research in people with CHF studying dyspnoea as a primary endpoint remains sparse. However, attention is turning towards symptoms as well as survival, and the need for agreed outcome measurement is recognized. There is relevant recent work examining both pharmacological and nonpharmacological interventions, targeting breathlessness directly or indirectly. There is evidence to support exercise training and mindfulness based programmes. The safety of morphine for breathlessness in acute heart failure has been retrospectively analysed but controlled clinical trials are required. Sildenafil may be useful for dyspnoea in CHF due to reduction of peripheral muscle signalling. Rolophylline, relaxin, carperitide, nesiritide and steroids warrant further evaluation. Bronchodilator use for dyspnoea in acute heart failure in the absence of COPD should be used with caution. A recent Cochrane review highlights the importance of diuretic therapy for both symptom control and optimizing prognosis. SUMMARY: Better standardization of dyspnoea outcome measures should help comparison of future trials. Optimization of diuretic therapy and attempted correction of neurohormonal disturbance in CHF remain the therapeutic targets for the underlying cause in dyspnoea management.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A greater focus on symptoms could enable promising alternative therapies such as relaxin and sildenafil to explore further, which have been yet to be formally approved due to unimproved mortality and hospitalization.
“A greater focus on symptoms could enable promising alternative therapies such as relaxin and sildenafil to explore further which have been yet to be formally approved due to unimproved mortality and hospitalization. 60”
From Prioritizing symptom management in the treatment of chronic heart failure (2020) · cites this paper as [60]
Cites
Publication Committee for the VMAC Investigators. (2002) · ACC Current Journal Review · doi:10.1016/s1062-1458(02)00795-x · Cited by 982 · see citing works
Gheorghiade, M., Abraham, W. T., Albert, N. M., Greenberg, B., O’Connor, C. M., She, L., Stough, W. G., Yancy, C. W., Young, J. B., Fonarow, G. C., et al. (2006) · JAMA · doi:10.1001/jama.296.18.2217 · Cited by 974 · see citing works
Flynn, K. E., Piña, I. L., Whellan, D. J., Lin, L., Blumenthal, J. A., Ellis, S. J., Fine, L. J., Howlett, J. G., Keteyian, S. J., Kitzman, D. W., et al. (2009) · JAMA · doi:10.1001/jama.2009.457 · Cited by 737 · see citing works
Glucocorticoids and cardiovascular disease
Walker, B. R. (2007) · European Journal of Endocrinology · doi:10.1530/eje-07-0455 · Cited by 529 · see citing works
Teerlink, J. R., Metra, M., Felker, G. M., Ponikowski, P. P., Voors, A. A., Davison, B. A., Marmor, A. T., Katz, A., Grzybowski, J., Unemori, E., et al. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60622-x · Cited by 422 · see citing works
Long-Term Use of Sildenafil in the Therapeutic Management of Heart Failure
Guazzi, M., Samaja, M., Arena, R. A., Vicenzi, M., & Guazzi, M. D. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.07.078 · Cited by 322 · see citing works
Measurement of breathlessness in advanced disease: A systematic review
Bausewein, C., Farquhar, M. C., Booth, S., Gysels, M., & Higginson, I. J. (2006) · Respiratory Medicine · doi:10.1016/j.rmed.2006.07.003 · Cited by 274 · see citing works
Corticosteroid-Induced Adverse Events in Adults
Fardet, L., Kassar, A., Cabané, J., & Flahault, A. (2007) · Drug Safety · doi:10.2165/00002018-200730100-00005 · Cited by 254 · see citing works
Morphine and outcomes in acute decompensated heart failure: an ADHERE analysis
Peacock, W. F., Hollander, J. E., Diercks, D. B., Lopatin, M., Fonarow, G. C., & Emerman, C. L. (2008) · Emergency Medicine Journal · doi:10.1136/emj.2007.050419 · Cited by 229 · see citing works
Symptoms in patients with heart failure are prognostic predictors: insights from COMET
Ekman, I., Cleland, J. G. F., Swedberg, K., Charlesworth, A., Metra, M., & Poole-Wilson, P. A. (2005) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2005.03.007 · Cited by 200 · see citing works
Sullivan, M. J., Wood, L., Terry, J., Brantley, J., Charles, A., McGee, V., Johnson, D., Krucoff, M. W., Rosenberg, B., Bosworth, H. B., et al. (2009) · American Heart Journal · doi:10.1016/j.ahj.2008.08.033 · Cited by 188 · see citing works
Cotter, G., Dittrich, H. C., Davison, B. A., Bloomfield, D. M., O’Connor, C. M., Metra, M., & Massie, B. M. (2008) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2008.08.010 · Cited by 171 · see citing works
Givertz, M. M., Massie, B. M., Fields, T. K., Pearson, L. L., & Dittrich, H. C. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.07.019 · Cited by 169 · see citing works
Dorman, S., Byrne, A., & Edwards, A. (2007) · Palliative Medicine · doi:10.1177/0269216307076398 · Cited by 150 · see citing works
Chua, T. P., Harrington, D., Ponikowski, P. P., Webb-Peploe, K., Poole-Wilson, P. A., & Coats, A. J. S. (1997) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(96)00446-9 · Cited by 141 · see citing works
Pang, P. S., Cleland, J. G. F., Teerlink, J. R., Collins, S. P., Lindsell, C. J., Sopko, G. S., Peacock, W. F., Fonarow, G. C., Aldeen, A. Z., Kirk, J., et al. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn048 · Cited by 136 · see citing works
Heart Failure Induced by Non-Cardiac Drugs
rdal, L. S., & Spigset, O. (2006) · Drug Safety · doi:10.2165/00002018-200629070-00003 · Cited by 118 · see citing works
Sertraline Effects on Dyspnea in Patients With Obstructive Airways Disease
Smoller, J. W., Pollack, M. H., Systrom, D., & Kradin, R. L. (1998) · Psychosomatics · doi:10.1016/s0033-3182(98)71377-5 · Cited by 116 · see citing works
Endogenous opioids modify dyspnoea during treadmill exercise in patients with COPD
Mahler, D., Murray, J. A., Waterman, L. A., Ward, J., Kraemer, W., Zhang, X., & Baird, J. (2009) · European Respiratory Journal · doi:10.1183/09031936.00145208 · Cited by 101 · see citing works
Dorman, S., Jolley, C. J., Abernethy, A. P., Currow, D. C., Johnson, M. J., Farquhar, M. C., Griffiths, G. O., Peel, T., Moosavi, S., Byrne, A., et al. (2009) · Palliative Medicine · doi:10.1177/0269216309102520 · Cited by 96 · see citing works
Self-citationNomura, F., Kurobe, N., Mori, Y., Hikita, A., Kawai, M., Suwa, M., & Okutani, Y. (2008) · Circulation Journal · doi:10.1253/circj.cj-07-0760 · Cited by 96 · see citing works
The Effects of Exercise Training on Fatigue and Dyspnea in Heart Failure
Pozehl, B., Duncan, K. A., & Hertzog, M. A. (2007) · European Journal of Cardiovascular Nursing · doi:10.1016/j.ejcnurse.2007.08.002 · Cited by 73 · see citing works
Singer, A. J., Emerman, C. E., Char, D. M., Heywood, J. T., Kirk, J. D., Hollander, J. E., Summers, R. L., Lee, C. C., Wynne, J., Kellerman, L., et al. (2008) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2007.04.005 · Cited by 69 · see citing works
Sertraline for chronic obstructive pulmonary disease and comorbid anxiety and mood disorders
Papp, L. A., Weiss, J. R., Greenberg, H. E., Rifkin, A. E., Scharf, S. M., Gorman, J. M., & Klein, D. F. (1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.10.1531a · Cited by 62 · see citing works
Johnson, M. J., Oxberry, S. G., Cleland, J. G. F., & Clark, A. L. (2010) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfp194 · Cited by 61 · see citing works
Self-citationNebulized Furosemide for the Management of Dyspnea: Does the Evidence Support Its Use?
Newton, P. J., Davidson, P. M., Macdonald, P., Ollerton, R. L., & Krum, H. (2008) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2007.10.017 · Cited by 55 · see citing works
Guazzi, M., & Samaja, M. (2007) · Current Medicinal Chemistry · doi:10.2174/092986707781389619 · Cited by 52 · see citing works
Peacock, W. F., Emerman, C. L., & Silver, M. A. (2005) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2004.11.002 · Cited by 39 · see citing works
Miller, A. H., Nazeer, S. R., Pepe, P. E., Estes, B., Gorman, A., & Yancy, C. W. (2008) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2007.12.003 · Cited by 38 · see citing works
Rolofylline: a selective adenosine 1 receptor antagonist for the treatment of heart failure
Slawsky, M., & Givertz, M. M. (2009) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656560802682213 · Cited by 37 · see citing works
Prednisone Adding to Usual Care Treatment for Refractory Decompensated Congestive Heart Failure
Zhang, H., Liu, C., Ji, Z., Liu, G., Zhao, Q., Ao, Y. G., Wang, L., Deng, B., Zhen, Y., Li, T. X., et al. (2008) · International Heart Journal · doi:10.1536/ihj.49.587 · Cited by 33 · see citing works
Boni, E., Bezzi, M., Carminati, L., Corda, L., Grassi, V., & Tantucci, C. (2005) · CHEST Journal · doi:10.1378/chest.128.2.1050 · Cited by 23 · see citing works
Perna, G., Cogo, R., & Bellodi, L. (2004) · Depression and Anxiety · doi:10.1002/da.20041 · Cited by 19 · see citing works
Review of the evidence for the management of dyspnoea in people with chronic heart failure
Oxberry, S. G., & Johnson, M. J. (2008) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0b013e3282ff122e · Cited by 19 · see citing works
Self-citationThe origin of symptoms in chronic heart failure
CLARK, A. L., & MCDONAGH, T. (1997) · Heart · doi:10.1136/hrt.78.5.429 · Cited by 16 · see citing works
Design and Rationale of the URGENT Dyspnea Study: An International, Multicenter, Prospective Study
Pang, P. S., Tavares, M., Collins, S. P., Cleland, J. G. F., Hollander, J. E., Nieminen, M. S., Miller, C. D., Courtney, D. M., Kirk, J. D., Masip, J., et al. (2008) · American Journal of Therapeutics · doi:10.1097/mjt.0b013e31816b436e · Cited by 14 · see citing works
Peacock, W. F. (2006) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2006.10.001 · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Bekelman, D. B., Allen, L. A., McBryde, C. F., Hattler, B. G. J., Fairclough, D. L., Havranek, E. P., Turvey, C., & Meek, P. (2018) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.8667 · Cited by 187 · see citing works
Prioritizing symptom management in the treatment of chronic heart failure
Koshy, A. O., Gallivan, E. R., McGinlay, M., Straw, S., Drozd, M., Toms, A. G., Gierula, J., Cubbon, R. M., Kearney, M. T., & Witte, K. K. (2020) · ESC Heart Failure · doi:10.1002/ehf2.12875 · Cited by 66 · see citing works
Bekelman, D. B., Hooker, S. A., Nowels, C. T., Main, D. S., Meek, P., McBryde, C. F., Hattler, B. G. J., Lorenz, K., & Heidenreich, P. A. (2013) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.0143 · Cited by 47 · see citing works
Aucoin, R., Lewthwaite, H., Ekström, M. P., von Leupoldt, A., & Jensen, D. (2023) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2023.104036 · Cited by 24 · see citing works
Maddocks, M. M., Brighton, L. J., Farquhar, M. C., Booth, S., Miller, S., Klass, L., Tunnard, I., Yi, D., Gao, W., Bajwah, S., et al. (2019) · Health Services and Delivery Research · doi:10.3310/hsdr07220 · Cited by 22 · see citing works
Flexible Diuretic Titration in Chronic Heart Failure: Where Is the Evidence?
Piano, M. R., Prasun, M. A., Stamos, T. D., & Groo, V. L. (2011) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2011.10.001 · Cited by 20 · see citing works
Vicent, L., Olarte, J. M. N., Puente‐Maestu, L., Oliva, A., López‐Azor, J. C., Postigo, A., de Miguel, I. M., Luna‐López, R., Fernández‐Avilés, F., & Martínez‐Sellés, M. (2017) · BMC Palliative Care · doi:10.1186/s12904-017-0208-x · Cited by 20 · see citing works
Ekman, I., Granger, B. B., Swedberg, K. B., Stenlund, H. C., & Boman, K. (2011) · European Journal of Heart Failure · doi:10.1093/eurjhf/hfr062 · Cited by 19 · see citing works
Williams, M. (2011) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0b013e328345d4a1 · Cited by 13 · see citing works
Identification of factors associated with social dysfunction in patients with heart failure
Wang, L., Fang, W., An, Y., Chen, C., & Fan, X. (2021) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvaa027 · Cited by 10 · see citing works
Nirmalasari, N. (2017) · NurseLine Journal · doi:10.19184/nlj.v2i2.5940 · Cited by 4 · see citing works
Ganglani, V., & Geng, Y. (2024) · Cells Tissues Organs · doi:10.1159/000539593 · Cited by 4 · see citing works
Nirmalasari, N. (2020) · JNKI (Jurnal Ners dan Kebidanan Indonesia) (Indonesian Journal of Nursing and Midwifery) · doi:10.21927/jnki.2019.7(2).68-73 · Cited by 2 · see citing works
Glucocorticoids for decompensated heart failure
Wang, N., Qiao, M., Meng, H., & Liu, C. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010879 · Cited by 2 · see citing works
RetractedManejo paliativo de la disnea en el paciente terminal
Valdy, G. C., Ferrandino-Carballo, M., & Herrera, I. S. (2011) · Acta Médica Costarricense · doi:10.51481/amc.v53i2.729 · Cited by 1 · see citing works
What Interventions Are Effective for Managing Dyspnea in Heart Failure?
Goldstein, N. E., & Ascheim, D. D. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-3796-7.00023-9 · Cited by 1 · see citing works
Glucocorticoids for decompensated heart failure
Wang, N., Qiao, M., Meng, H., & Liu, C. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010879.pub2 · Cited by 1 · see citing works
Opiates in Acute Heart Failure: More Harmful than Beneficial
Verbraecken, J. A. (2019) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201907-491ed · Cited by 1 · see citing works
Palliative Management of Dyspnea in the Terminal Patient
Carvajal-Valdy, G., Ferrandino-Carballo, M., & Herrera, I. S. (2011) · Acta Médica Costarricense
Carvajal-Valdy, G., Ferrandino-Carballo, M., & Herrera, I. S. (2011) · DOAJ (DOAJ: Directory of Open Access Journals)
Supportive and Palliative Care and Issues in Cardio-oncology
Wordingham, S. E., & Swetz, K. M. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-44227-5.00020-x
(2011) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0b013e3283473351
Recent Literature Feature Editor: Paul C. Rousseau
(2010) · Journal of Palliative Medicine · doi:10.1089/jpm.2010.9771
Recent Literature Feature Editor: Paul C. Rousseau
(2010) · Journal of Palliative Medicine · doi:10.1089/jpm.2010.9784
ปจจยทำนายอาการหายใจลำบากในผปวยภาวะหวใจลมเหลว
เทียมพิทักษ์, ภ. (2020) · doi:10.58837/chula.the.2020.902
Tarekegn, G. Y., Chelkeba, L., Moges, T. A., Dagnew, F. N., Dagnew, S. B., Anberbr, S. S., & Tesfaye, B. T. (2025) · American Heart Journal Plus Cardiology Research and Practice · doi:10.1016/j.ahjo.2025.100665
- Authors
- Johnson, M. J., & Oxberry, S. G.
- Affiliations
- Hull York Medical School (GB)
- Corresponding author
- Johnson, Miriam J
- ORCID
- Johnson, Miriam J
- Venue
- Current Opinion in Supportive & Palliative Care
- Published
- 2010-06
- Volume
- 4
- Issue
- 2
- Pages
- 63-68
- ISSN
- 1751-4258 (ISSN-L)
- OpenAlex
- W1970933963
- Cited by
- 26
- References
- 37
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2021: 1 · 2020: 3 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 1 · 2015: 1 · 2013: 2 · 2012: 1
- FWCI
- 0.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Supportive and Palliative Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- dyspnea, chronic heart failure, breathlessness management, diuretic therapy, exercise training, mindfulness-based interventions, morphine, sildenafil, nesiritide, carperitide, relaxin, bronchodilators, neurohormonal activation, acute heart failure
- MeSH terms
- Contraindications, Bronchodilator Agents, Combined Modality Therapy, Diuretics, Dyspnea, Exercise Therapy, Heart Failure, Humans, Morphine, Narcotics, Vasodilator Agents, Mind-Body Therapies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
