SOURCE: Miró Ò, Gil V, Martín-Sánchez FJ, et al. Chest 2017;152:821-832.

Patients who experience acute heart failure (aHF) often are burdened with distressing dyspnea and its concomitant heightening of anxiety. Historically, clinicians have used morphine in these situations.

These decisions have been based on physiologic effects, such as preload and afterload reduction, as well as putative central nervous system effects, including reduced anxiety, breathlessness, and pain.

Unfortunately, morphine use in such settings is neither adequately supported nor refuted by clinical trial data.

Miró et al reviewed the data on a large population of aHF patients between 2011 and 2014 (n = 6,516). Investigators compared persons who received IV morphine within three hours of admission to an emergency department to those who did not.

From this larger population of aHF patients, a subgroup who could be matched for a wide variety of other variables was selected for analysis (n = 550). Patients treated with morphine demonstrated a hazard ratio for 30-day mortality of 1.66.

The authors suggested that based on these data, clinicians should avoid morphine use in aHF patients.