Adverse dose-dependent effects of morphine therapy in acute heart failure

Caspi, Oren; Naami, Robert; Halfin, Elya; Aronson, Doron

doi:10.1016/j.ijcard.2019.06.015

Cited by 28 publications

(30 citation statements)

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“…However, the heterogeneity of treatment effect has not been shown in the above-mentioned studies. 12,58 The association between morphine therapy and adverse events in AHF is complex, and likely requires the coexistence of several risk factors/patient susceptibilities to progress to a clinical event. Given the inability to acquire all the relevant patient data at the appropriate temporal resolution, causality remains to be established.…”

Section: Resultsmentioning

confidence: 99%

“…During the last decade, however, several retrospective studies raised concerns regarding the safety and efficacy of morphine in the setting of AHF. [ 9 – 12 ] In the current review, the physiological effects of morphine on the cardiovascular and respiratory systems are summarised, as well as the potential clinical benefits and risks. This is followed by a discussion on the reported clinical outcomes associated with morphine treatment in AHF.…”

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confidence: 99%

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Morphine in the Setting of Acute Heart Failure: Do the Risks Outweigh the Benefits?

Caspi

Aronson

2020

Card Fail Rev

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The use of opioids in acute pulmonary oedema is considered standard therapy by many physicians. The immediate relieving effect of morphine on the key symptomatic discomfort associated with acute heart failure, dyspnoea, facilitated the categorisation of morphine as a beneficial treatment in this setting. During the last decade, several retrospective studies raised concerns regarding the safety and efficacy of morphine in the setting of acute heart failure. In this article, the physiological effects of morphine on the cardiovascular and respiratory systems are summarised, as well as the potential clinical benefits and risks associated with morphine therapy. Finally, the reported clinical outcomes and adverse event profiles from recent observational studies are discussed, as well as future perspectives and potential alternatives to morphine in the setting of acute heart failure.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Morphine in the Setting of Acute Heart Failure: Do the Risks Outweigh the Benefits?

Caspi

Aronson

2020

Card Fail Rev

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“…demonstrated a strong relationship between morphine dosage and in-hospital mortality (17.4% vs 13.4%, OR = 1.43). Additionally, intravenous morphine use signi cantly contributed to a marked risk for the need for additional mechanical ventilation (7.4% vs 3.6%, OR = 2.13) [14]. The following factors may explain these results.…”

Section: Discussionmentioning

confidence: 99%

Correlations Between Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: A Retrospective Study

Lin

Yuan

zhu

et al. 2020

Preprint

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Background: The available data regarding the safety of morphine use in cases of STEMI with AHF (Killip ≥2) remain insufficient. The aim of the study was to further examine the safety of intravenous morphine in patients with STEMI and AHF over 1 year of follow-up after primary percutaneous coronary intervention (PPCI).Methods: 275 consecutive patients with STEMI and AHF were included and divided into groups that did or did not receive in-hospital intravenous morphine. Endpoints included major adverse cardiovascular events (MACEs) and the need for invasive mechanical ventilation during hospitalization and 1 year of follow-up. Results: The in-hospital occurrences of cardiac death and cardiogenic shock were much higher in patients who received morphine than that those who did not (15.20% vs 6.67%, p=0.035; odds ratio [OR]=2.509, 95% confidence interval [CI] 1.121–5.620, and 14.40% vs 6.00%, p=0.033; OR=2.636, 95% CI 1.139-6.097, respectively). Additionally, more patients in the group treated with morphine experienced the secondary outcome of in-hospital invasive mechanical ventilation compared with the group not treated with morphine (19.20% vs 10.67%, p=0.031; OR=2.308, 95% CI 1.138–4.684). However, no difference between-group differences were observed for the incidence of MACEs, cardiac death, or all-cause death over 1 year of follow-up.Conclusions: Intravenous morphine administration is highly correlated with in-hospital MACEs and the need for additional invasive mechanical ventilation in STEMI patients with AHF after PPCI, but not for long-time adverse outcomes.

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“…Of these, we excluded 303 duplicated articles, 414 articles that did not fulfill the inclusion criteria, and 1 article that was not written in English. Thus, three propensity-matched cohorts [7][8][9] and one retrospective analysis [6] were included. Additionally, we included our own unpublished study, "Correlations between Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: a retrospective study" which was a retrospective analysis available as a preprint on Research Square [10].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…For several decades, morphine has been recommended for the improvement of severe pulmonary edema in AHF based on a class-IIb level of evidence [3,4]. However, intravenous morphine has been reported to produce adverse effects, such as nausea, hypotension, myocardial depression, and brainstem/respiratory center suppression (which increases the need for mechanical ventilation), in patients with AHF, thereby increasing the risk of poor clinical outcomes [5][6][7][8][9]. Although morphine has long been used to treat AHF patients, no consensus has yet been reached on the potential mortality risk of patients receiving morphine treatment.…”

Section: Introductionmentioning

confidence: 99%

Intravenous morphine use in acute heart failure increases adverse outcomes: a meta-analysis

Lin¹,

Chen²,

Yuan³

et al. 2021

Reviews in Cardiovascular Medicine

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Intravenous morphine is a controversial treatment for acute heart failure (AHF). This study aimed to evaluate and compare the efficacy of intravenous morphine treatment vs. no morphine treatment in AHF patients. Relevant research conducted before June 2020 was retrieved from electronic databases. One unpublished study of our own was also included. Studies were eligible for inclusion if they compared AHF patients treated with intravenous morphine and patients who did not receive morphine. This meta-analysis included three propensity-matched cohorts and two retrospective analyses, involving a total of 149,967 patients (intravenous-morphine group, n = 22,072; no-morphine group, n = 127,895). There was a non-significant increase in the in-hospital mortality in the morphine group (combined odds ratio [OR] = 2.14, 95% confidence interval [CI]: 0.88-5.23, p = 0.095, I 2 = 97.1%). However, subgroup analyse showed that the rate of in-hospital mortality with odds of 1.41 times more likely (95% CI: 1.11-1.80, p = 0.005, I 2 = 0%) in those receiving vs. not receiving intravenous morphine. No significant correlation was found between intravenous morphine and invasive mechanical ventilation (OR = 2.19, 95% CI: 0.84-5.73, p = 0.10, I 2 = 94.2%; subgroup analysis: OR = 2.24, 95% CI: 0.70-7.21, p = 0.176, I 2 = 95.1%) or long-term mortality (hazard ratio = 1.15, 95% CI: 0.96-1.34, p = 0.335; I 2 = 8.6%). The administration of intravenous morphine to patients with AHF may be related to in-hospital mortality, but not to invasive mechanical ventilation and long-term mortality.

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Adverse dose-dependent effects of morphine therapy in acute heart failure

Cited by 28 publications

References 30 publications

Morphine in the Setting of Acute Heart Failure: Do the Risks Outweigh the Benefits?

Morphine in the Setting of Acute Heart Failure: Do the Risks Outweigh the Benefits?

Correlations Between Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: A Retrospective Study

Intravenous morphine use in acute heart failure increases adverse outcomes: a meta-analysis

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Adverse dose-dependent effects of morphine therapy in acute heart failure

Cited by 28 publications

References 30 publications

Morphine in the Setting of Acute Heart Failure: Do the Risks Outweigh the Benefits?

Morphine in the Setting of Acute Heart Failure: Do the Risks Outweigh the Benefits?

Correlations Between&nbsp;Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: A Retrospective Study

Intravenous morphine use in acute heart failure increases adverse outcomes: a meta-analysis

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Correlations Between Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: A Retrospective Study