Morphine in acute heart failure

Agewall, Stefan

doi:10.21037/jtd.2017.06.129

Cited by 11 publications

(16 citation statements)

References 24 publications

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“…Excessive depression of respiratory function may be a crucial cause of induction of invasive ventilation. The negative effect of respiratory depression was also emphasized in past studies, which possibly led to intubation and ventilator therapy 9 . Another important mechanism might be the hypotension induced by hemodynamic change.…”

Section: Discussionmentioning

confidence: 97%

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: Discussionmentioning

confidence: 97%

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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“…There are also reported cases of CS occurring after the administration of opioids different from morphine, such as tramadol [25] or dextropropoxyphene [26]. Moreover, there is a widely observed effect on mortality of the patients treated with morphine during acute heart failure or acute coronary syndromes [7][8][9][10][11], but because of the lack of randomized clinical trials and observational characteristics of the conducted studies, it is impossible to draw definite conclusions on that subject. However, the guidelines of the European Cardiovascular Society report the suspected effect on mortality and recommend not to use morphine routinely in acute heart failure with an exception of cases with severe dyspnea and pulmonary edema [7].…”

Section: Discussionmentioning

confidence: 99%

“…It is widely used as a medication, most often in chronic pain treatment [5], hemorrhagic shock [6], or acute heart failure accompanied by pulmonary edema with severe dyspnea [7]. Although it is clear that the therapeutic use of morphine has many positive effects, there are studies that bring up concerns about serious side effects and risks associated with its use, such as reported a higher mortality among the patients treated with morphine in acute heart failure or with acute coronary syndromes [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Cardiogenic shock induced by a high dose of intravenous morphine

Anand¹,

Korolkiewicz²,

Anand³

2021

Int J Occup Med Environ Health

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“…Finally, the haemodynamic effects of morphine can, directly and indirectly, affect urine output and renal function, resulting in decreased urine output in the setting of AHF. 18,28,55,56 Morphine Therapy and Clinical Outcomes in Acute Heart Failure p=0.024). Morphine therapy was also associated with a significant increase in the use of inotropes, non-invasive ventilation and acute kidney injury.…”

Section: Potential Clinical Risks Of Morphine In the Treatment Of Acumentioning

confidence: 99%

Section: Potential Clinical Risks Of Morphine In the Treatment Of Acumentioning

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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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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Morphine in acute heart failure

Cited by 11 publications

References 24 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

Cardiogenic shock induced by a high dose of intravenous morphine

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

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