title: Use of intravenous morphine for acute decompensated heart failure in patients with and without acute coronary syndromes.
abstract: BACKGROUND
  Current guidelines regarding the use of intravenous morphine (IM) in the management of patients with acute decompensated heart failure (ADHF) are discordant; whereas the American guidelines reserve IM for terminal patients, the European guidelines recommend its use in the early stage of treatment. Our aim was to determine the impact of IM on outcomes of ADHF patients.
  
  
  METHODS
  Stepwise logistic regression and propensity score analysis of ADHF patients with and without use of IM was performed in a national heart failure survey.
  
  
  RESULTS
  Of the 4102 enrolled patients, we identified 2336 ADHF patients, of whom 218 (9.3%) received IM. IM patients were more likely to have acute coronary syndromes, acute rather than exacerbation of chronic heart failure, and diabetes mellitus and dyslipidemia. They had higher heart rate, were less likely to receive diuretics and more likely to receive aspirin and statins. Unadjusted in-hospital mortality rates were 11.5% versus 5.0% for patients who did or did not receive IM, and the adjusted odds ratio (OR) for in-hospital death was: 2.0 (1.1 – 3.5, P = 0.02). Using propensity analysis, we identified 218 matched pairs of patients who did or did not receive IM. In multivariable analysis accounting for the propensity score (c-statistic 0.82), IM was not associated with increased in-hospital death (OR: 1.2 (0.6 – 2.4), P = 0.55).
  
  
  CONCLUSIONS
  IM was used sparingly in our ADHF cohort, and was independently associated with increased in-hospital death in multivariable analysis, but not in propensity score analysis. Thus, IM may be used in ADHF, but with caution. Further randomized trials are warranted.
authors.affiliation: Department of Cardiology, Rabin Medical Center, Beilinson Hospital and the Lea Weissman Cardiology Research Institute, Petah Tikva, Israel.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Iakobishvili
authors.forename: Eytan
authors.initials: E
authors.lastname: Cohen
authors.forename: Moshe
authors.initials: M
authors.lastname: Garty
authors.forename: Solomon
authors.initials: S
authors.lastname: Behar
authors.forename: Avraham
authors.initials: A
authors.lastname: Shotan
authors.forename: Amir
authors.initials: A
authors.lastname: Sandach
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Aviv
authors.initials: A
authors.lastname: Mager
authors.forename: Alexander
authors.initials: A
authors.lastname: Battler
authors.forename: David
authors.initials: D
authors.lastname: Hasdai
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006306:Health Surveys; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009020:Morphine / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D009020:Morphine