Morphine Shortens Recovery from Acute Decompensated Heart Failure Categorized as Clinical Scenario 1 without Worsening Respiration

Abstract

BackgroundMorphine has a potency to reduce distress associated with dyspnea, and reduce preload via venodilatation.Therefore, morphine is recommended for a treatment of acute decompensated heart failure (ADHF) by guidelines.However, there is little evidence showing the effects of morphine on the rapid improvement of ADHF. Here, we aimed to reveal the clinical benefit of morphine in patients with ADHF categorized as clinical scenario 1 (CS1).MethodsThe subjects were 86 patients with ADHF categorized as CS1 who were delivered to emergency room (ER) in our hospital from January 2011 to February 2014. We retrospectively surveyed medications used in ER, changes of blood pressure (BP), heart rate (HR) and respiratory rate (RR) until an hour after hospitalization.ResultsIn the patients with morphine administration, the time to reach RR <20/min was shorter (p=0.016), and the reduction ratio of HR was higher (p=0.001). Multivariate logistic analysis adjusted for age, gender, RR, the use of non-invasive positive-pressure ventilation revealed that the use of morphine, but not nitrates or diuretic, was independently associated with the accomplishment of BP <140 mmHg (p=0.04), RR <20/min (p=0.003), reduction rate of HR ≥20% (p=0.0006) at 30 minutes after hospitalization. There were no patients who developed respiratory failure requiring intubation after morphine use.ConclusionMorphine may shorten the recovery from ADHF categorized as CS1 without worsening respiration. BackgroundMorphine has a potency to reduce distress associated with dyspnea, and reduce preload via venodilatation.Therefore, morphine is recommended for a treatment of acute decompensated heart failure (ADHF) by guidelines.However, there is little evidence showing the effects of morphine on the rapid improvement of ADHF. Here, we aimed to reveal the clinical benefit of morphine in patients with ADHF categorized as clinical scenario 1 (CS1). Morphine has a potency to reduce distress associated with dyspnea, and reduce preload via venodilatation. Therefore, morphine is recommended for a treatment of acute decompensated heart failure (ADHF) by guidelines. However, there is little evidence showing the effects of morphine on the rapid improvement of ADHF. Here, we aimed to reveal the clinical benefit of morphine in patients with ADHF categorized as clinical scenario 1 (CS1). MethodsThe subjects were 86 patients with ADHF categorized as CS1 who were delivered to emergency room (ER) in our hospital from January 2011 to February 2014. We retrospectively surveyed medications used in ER, changes of blood pressure (BP), heart rate (HR) and respiratory rate (RR) until an hour after hospitalization. The subjects were 86 patients with ADHF categorized as CS1 who were delivered to emergency room (ER) in our hospital from January 2011 to February 2014. We retrospectively surveyed medications used in ER, changes of blood pressure (BP), heart rate (HR) and respiratory rate (RR) until an hour after hospitalization. ResultsIn the patients with morphine administration, the time to reach RR <20/min was shorter (p=0.016), and the reduction ratio of HR was higher (p=0.001). Multivariate logistic analysis adjusted for age, gender, RR, the use of non-invasive positive-pressure ventilation revealed that the use of morphine, but not nitrates or diuretic, was independently associated with the accomplishment of BP <140 mmHg (p=0.04), RR <20/min (p=0.003), reduction rate of HR ≥20% (p=0.0006) at 30 minutes after hospitalization. There were no patients who developed respiratory failure requiring intubation after morphine use. In the patients with morphine administration, the time to reach RR <20/min was shorter (p=0.016), and the reduction ratio of HR was higher (p=0.001). Multivariate logistic analysis adjusted for age, gender, RR, the use of non-invasive positive-pressure ventilation revealed that the use of morphine, but not nitrates or diuretic, was independently associated with the accomplishment of BP <140 mmHg (p=0.04), RR <20/min (p=0.003), reduction rate of HR ≥20% (p=0.0006) at 30 minutes after hospitalization. There were no patients who developed respiratory failure requiring intubation after morphine use. ConclusionMorphine may shorten the recovery from ADHF categorized as CS1 without worsening respiration. Morphine may shorten the recovery from ADHF categorized as CS1 without worsening respiration.