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

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

doi:10.1016/j.ijcard.2019.11.143

Cited by 3 publications

(7 citation statements)

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“…Four studies with 22 047 cases/167847 patients assessed the risk of invasive mechanical ventilation 4,5,14,24 . The results showed that morphine treatment was associated with an increased risk of invasive ventilation incidence (OR 2.72; 95% CI 1.09 to 6.80; p = 0.03, I 2 = 93%) in patients with AHF compared with the control group (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies with 22 967 cases and 172 226 patients with AHF were included in this meta‐analysis. 4 , 5 , 6 , 7 , 14 , 23 , 24 Overall, these seven studies were published from 1999 to 2019 and emerged from different countries, including Spain, 14 , 23 USA, 4 , 5 Israel, 6 , 24 and UK. 7 The sample sizes of the included studies varied from 181 to 147 362.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies with 22 338 cases/170993 patients contributed to data for this outcome 5 , 6 , 14 , 23 , 24 The pooled OR showed that there were no differences in in‐hospital mortality between the morphine and control groups with high heterogeneity (OR: 1.94; 95% CI 0.93 to 4.03; p = 0.08, I 2 = 96%) (Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, due to data restrictions, we could not further analyze the effects of effective dosage or the different administration approaches of morphine in patients with AHF. Only Caspi O et al 24 investigated the effects of administered amounts and found that there was a significant linear dependency between the incidence of invasive mechanical ventilation and the dose of morphine.…”

Section: Discussionmentioning

confidence: 99%

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The safety of morphine in patients with acute heart failure: A systematic review and meta‐analysis

Zhang

Wei

Liu

et al. 2021

Clinical Cardiology

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While morphine has long been widely used in treating acute heart failure (AHF) due to its vasodilatory properties and anticipated anxiolysis, it remains unclear whether the application of morphine to those patients is reasonable. We aim to conduct a systematic review and meta‐analysis to assess the safety of morphine in patients with AHF. We searched PubMed, Cochrane Library, and Embase electronic databases from inception through March 2020. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the outcomes. Seven studies with 172, 226 patients were included. The results showed that morphine usage was not associated with increased in‐hospital mortality (OR: 1.94; 95% CI 0.93 to 4.03; p = 0.08). However, the use of morphine significantly increased the risk of invasive ventilation (OR: 2.72; 95% CI 1.09 to 6.80; p = 0.03). Furthermore, the subgroup analysis indicated that the application of morphine was not associated with increased 7‐day all‐cause mortality in patients with AHF (OR: 1.69; 95% CI 0.80 to 3.22; p = 0.11) but significantly increased the risk of 30‐day all‐cause mortality (OR: 1.59; 95% CI 1.16 to 2.17; p = 0.004). Based on current evidence, our results suggested that although morphine therapy did not significantly increase the risk of short‐term death (in the hospital or within 7 days) in patients with AHF, the risk of long‐term death and invasive ventilation were significantly increased. This result needs to be further confirmed by an ongoing randomized control trial.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The safety of morphine in patients with acute heart failure: A systematic review and meta‐analysis

Zhang

Wei

Liu

et al. 2021

Clinical Cardiology

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“…Caspi et al 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 

Dong

Lin

Yuan

et al. 2020

Preprint

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Background: Studies examining the safety of intravenous morphine use for acute heart failure (AHF) have reported inconsistent results. Objective: The comprehensive meta-analysis assessed and compared the clinical outcomes of intravenous morphine use in AHF.Methods: We formally searched electronic databases before June 2020 to identify potential studies. All clinical trials were eligible for inclusion if they compared intravenous morphine or not in patients with AHF.Results: 3 propensity-matched cohorts and 2 retrospective analysis with a total of 151867 patients met the inclusion criteria were included in our meta-analysis (intravenous morphine group=22072, without morphine group=127895). The use of intravenous morphine was associated with increased risk of in-hospital mortality [over all odds ratio (OR)=5.49, 95% confidence interval (CI) 5.20 to 5.79, p<0.001, I2=96.7%; subgroup analysis: OR=1.60, 95%CI 1.27-2.02, I2=0%; OR=1.53, 95%CI 1.20-1.96, I2=7%] and invasive mechanical ventilation (OR=6.08, 95% CI 5.79 to 6.40, p<0.001, I2=94.2%; subgroup analysis: OR=1.74, 95%CI 1.21-2.49, I2=62.3%). However, there was no significant association of longtime time mortality with intravenous morphine (Hazards ratio =1.17; 95% CI 0.99–1.36, p=0.14; I2 32%).Conclusion: In AHF patients, intravenous morphine administration for relieving dyspnea was associated with in-hospital mortality and invasive mechanical ventilation, but not for longtime mortality.

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Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction

Ostrominski

Vaduganathan

2022

Clinical Cardiology

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Heart failure (HF) is a chronic, progressive, and increasingly prevalent syndrome characterized by stepwise declines in health status and residual lifespan. Despite significant advancements in both pharmacologic and nonpharmacologic management approaches for chronic HF, the burden of HF hospitalization—whether attributable to new‐onset (de novo) HF or worsening of established HF—remains high and contributes to excess HF‐related morbidity, mortality, and healthcare expenditures. Owing to a paucity of evidence to guide tailored interventions in this heterogeneous group, management of acute HF events remains largely subject to clinician discretion, relying principally on alleviation of clinical congestion, as‐needed correction of hemodynamic perturbations, and concomitant reversal of underlying trigger(s). Following acute stabilization, the subsequent phase of care primarily involves interventions known to improve long‐term outcomes and rehospitalization risk, including initiation and optimization of disease‐modifying pharmacotherapy, targeted use of adjunctive therapies, and attention to contributing comorbid conditions. However, even with current standards of care many patients experience recurrent HF hospitalization, or after admission incur worsening clinical trajectories. These patterns highlight a persistent unmet need for evidence‐based approaches to inform in‐hospital HF care and call for renewed focus on urgent implementation of interventions capable of ameliorating risk of worsening HF. In this review, we discuss key contemporary and emerging therapeutic strategies for patients hospitalized with de novo or worsening HF.

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

Cited by 3 publications

References 5 publications

The safety of morphine in patients with acute heart failure: A systematic review and meta‐analysis

The safety of morphine in patients with acute heart failure: A systematic review and meta‐analysis

Correlations between Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: a retrospective study

Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction

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

Cited by 3 publications

References 5 publications

The safety of morphine in patients with acute heart failure: A systematic review and meta‐analysis

The safety of morphine in patients with acute heart failure: A systematic review and meta‐analysis

Correlations between&nbsp;Morphine Use and Adverse Outcomes in Acute ST-Segment Elevation Myocardial Infarction with Acute Heart Failure: a retrospective study&nbsp;

Evolving therapeutic strategies for patients hospitalized with new or worsening heart failure across the spectrum of left ventricular ejection fraction

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Product

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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