Morphine and outcomes in acute decompensated heart failure: An ADHERE analysis

W. F. Peacock, J. E. Hollander, D. B. Diercks, M. Lopatin, G. Fonarow, C. L. Emerman

Research output: Contribution to journalArticle

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Abstract

Objective: Morphine is a long-standing therapy in acute decompensated heart failure (ADHF), despite few supporting data. A study was undertaken to compare the outcomes of patients who did and did not receive morphine for ADHF. Methods: The study was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE) which enrols hospitalised patients with treatment for, or a primary discharge diagnosis of, ADHF. Patients were stratified into cohorts based on whether or not they received intravenous morphine. ANOVA, Wilcoxon and χ2 tests were used in univariate analysis, followed by multivariate analysis controlling for parameters previously associated with mortality. Analyses were repeated for ejection fraction subgroups and in patients not on mechanical ventilation. Results: There were 147 362 hospitalisations in ADHERE at December 2004, 20 782 of whom (14.1%) received morphine and 126 580 (85.9%) did not. There were no clinically relevant differences between the groups in the initial age, heart rate, blood pressure, blood urea nitrogen, creatinine, haemoglobin. ejection fraction or atrial fibrillation. A higher prevalence of rest dyspnoea, congestion on chest radiography, rales and raised troponin occurred in the morphine group. Patients on morphine received more inotropes and vasodilators, were more likely to require mechanical ventilation (15.4% vs 2.8%), had a longer median hospitalisation (5.6 vs 4.2 days), more ICU admissions (38.7% vs 14.4%), and had greater mortality (13.0% vs 2.4%) (all p<0.001). Even after risk adjustment and exclusion of ventilated patients, morphine was an independent predictor of mortality (OR 4.84 (95% Cl 4.52 to 5.18), p<0.001). Conclusions: Morphine is associated with increased adverse events in ADHF which includes a greater frequency of mechanical ventilation, prolonged hospitalisation, more ICU admissions and higher mortality.

Original languageEnglish (US)
Pages (from-to)205-209
Number of pages5
JournalEmergency Medicine Journal
Volume25
Issue number4
DOIs
StatePublished - Apr 2008

Fingerprint

Morphine
Registries
Heart Failure
Artificial Respiration
Hospitalization
Mortality
Risk Adjustment
Troponin
Blood Urea Nitrogen
Respiratory Sounds
Vasodilator Agents
Radiography
Dyspnea
Atrial Fibrillation
Creatinine
Analysis of Variance
Hemoglobins
Thorax
Multivariate Analysis
Heart Rate

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Nursing(all)
  • Emergency Medicine

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Morphine and outcomes in acute decompensated heart failure : An ADHERE analysis. / Peacock, W. F.; Hollander, J. E.; Diercks, D. B.; Lopatin, M.; Fonarow, G.; Emerman, C. L.

In: Emergency Medicine Journal, Vol. 25, No. 4, 04.2008, p. 205-209.

Research output: Contribution to journalArticle

Peacock, WF, Hollander, JE, Diercks, DB, Lopatin, M, Fonarow, G & Emerman, CL 2008, 'Morphine and outcomes in acute decompensated heart failure: An ADHERE analysis', Emergency Medicine Journal, vol. 25, no. 4, pp. 205-209. https://doi.org/10.1136/emj.2007.050419
Peacock, W. F. ; Hollander, J. E. ; Diercks, D. B. ; Lopatin, M. ; Fonarow, G. ; Emerman, C. L. / Morphine and outcomes in acute decompensated heart failure : An ADHERE analysis. In: Emergency Medicine Journal. 2008 ; Vol. 25, No. 4. pp. 205-209.
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abstract = "Objective: Morphine is a long-standing therapy in acute decompensated heart failure (ADHF), despite few supporting data. A study was undertaken to compare the outcomes of patients who did and did not receive morphine for ADHF. Methods: The study was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE) which enrols hospitalised patients with treatment for, or a primary discharge diagnosis of, ADHF. Patients were stratified into cohorts based on whether or not they received intravenous morphine. ANOVA, Wilcoxon and χ2 tests were used in univariate analysis, followed by multivariate analysis controlling for parameters previously associated with mortality. Analyses were repeated for ejection fraction subgroups and in patients not on mechanical ventilation. Results: There were 147 362 hospitalisations in ADHERE at December 2004, 20 782 of whom (14.1{\%}) received morphine and 126 580 (85.9{\%}) did not. There were no clinically relevant differences between the groups in the initial age, heart rate, blood pressure, blood urea nitrogen, creatinine, haemoglobin. ejection fraction or atrial fibrillation. A higher prevalence of rest dyspnoea, congestion on chest radiography, rales and raised troponin occurred in the morphine group. Patients on morphine received more inotropes and vasodilators, were more likely to require mechanical ventilation (15.4{\%} vs 2.8{\%}), had a longer median hospitalisation (5.6 vs 4.2 days), more ICU admissions (38.7{\%} vs 14.4{\%}), and had greater mortality (13.0{\%} vs 2.4{\%}) (all p<0.001). Even after risk adjustment and exclusion of ventilated patients, morphine was an independent predictor of mortality (OR 4.84 (95{\%} Cl 4.52 to 5.18), p<0.001). Conclusions: Morphine is associated with increased adverse events in ADHF which includes a greater frequency of mechanical ventilation, prolonged hospitalisation, more ICU admissions and higher mortality.",
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T2 - An ADHERE analysis

AU - Peacock, W. F.

AU - Hollander, J. E.

AU - Diercks, D. B.

AU - Lopatin, M.

AU - Fonarow, G.

AU - Emerman, C. L.

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N2 - Objective: Morphine is a long-standing therapy in acute decompensated heart failure (ADHF), despite few supporting data. A study was undertaken to compare the outcomes of patients who did and did not receive morphine for ADHF. Methods: The study was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE) which enrols hospitalised patients with treatment for, or a primary discharge diagnosis of, ADHF. Patients were stratified into cohorts based on whether or not they received intravenous morphine. ANOVA, Wilcoxon and χ2 tests were used in univariate analysis, followed by multivariate analysis controlling for parameters previously associated with mortality. Analyses were repeated for ejection fraction subgroups and in patients not on mechanical ventilation. Results: There were 147 362 hospitalisations in ADHERE at December 2004, 20 782 of whom (14.1%) received morphine and 126 580 (85.9%) did not. There were no clinically relevant differences between the groups in the initial age, heart rate, blood pressure, blood urea nitrogen, creatinine, haemoglobin. ejection fraction or atrial fibrillation. A higher prevalence of rest dyspnoea, congestion on chest radiography, rales and raised troponin occurred in the morphine group. Patients on morphine received more inotropes and vasodilators, were more likely to require mechanical ventilation (15.4% vs 2.8%), had a longer median hospitalisation (5.6 vs 4.2 days), more ICU admissions (38.7% vs 14.4%), and had greater mortality (13.0% vs 2.4%) (all p<0.001). Even after risk adjustment and exclusion of ventilated patients, morphine was an independent predictor of mortality (OR 4.84 (95% Cl 4.52 to 5.18), p<0.001). Conclusions: Morphine is associated with increased adverse events in ADHF which includes a greater frequency of mechanical ventilation, prolonged hospitalisation, more ICU admissions and higher mortality.

AB - Objective: Morphine is a long-standing therapy in acute decompensated heart failure (ADHF), despite few supporting data. A study was undertaken to compare the outcomes of patients who did and did not receive morphine for ADHF. Methods: The study was a retrospective analysis of the Acute Decompensated Heart Failure National Registry (ADHERE) which enrols hospitalised patients with treatment for, or a primary discharge diagnosis of, ADHF. Patients were stratified into cohorts based on whether or not they received intravenous morphine. ANOVA, Wilcoxon and χ2 tests were used in univariate analysis, followed by multivariate analysis controlling for parameters previously associated with mortality. Analyses were repeated for ejection fraction subgroups and in patients not on mechanical ventilation. Results: There were 147 362 hospitalisations in ADHERE at December 2004, 20 782 of whom (14.1%) received morphine and 126 580 (85.9%) did not. There were no clinically relevant differences between the groups in the initial age, heart rate, blood pressure, blood urea nitrogen, creatinine, haemoglobin. ejection fraction or atrial fibrillation. A higher prevalence of rest dyspnoea, congestion on chest radiography, rales and raised troponin occurred in the morphine group. Patients on morphine received more inotropes and vasodilators, were more likely to require mechanical ventilation (15.4% vs 2.8%), had a longer median hospitalisation (5.6 vs 4.2 days), more ICU admissions (38.7% vs 14.4%), and had greater mortality (13.0% vs 2.4%) (all p<0.001). Even after risk adjustment and exclusion of ventilated patients, morphine was an independent predictor of mortality (OR 4.84 (95% Cl 4.52 to 5.18), p<0.001). Conclusions: Morphine is associated with increased adverse events in ADHF which includes a greater frequency of mechanical ventilation, prolonged hospitalisation, more ICU admissions and higher mortality.

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