R.E.B.E:L.EM - August 2, 2018
"Article Being Reviewed: Miro, O. et al. Morphine Use in the ED and Outcomes of Patients with Acute Heart Failure: A Propensity Score-Matching Analysis Based on the EAHFE Registry. Chest 2017 Oct; 152(4): 821-832. PMID: 28411112
Author Conclusions: “The use of IV Morphine in patients with acute heart failure is associated with an increase in 30-day mortality.”
Clinical Take-Home Point: Due to the retrospective nature and methodological limitations of this study, strong conclusions cannot be made because of the potential for hidden confounders. This study does, however, add to the growing body of evidence against the use of morphine in the emergency department for patients with acute heart failure. Based on the results of this trial, patients presenting to the Emergency Department with Acute Heart Failure should not be routinely treated with morphine, as it is associated with a higher rate of mortality. Appropriate treatment of acute heart failure in the ED should focus on the optimization of hemodynamics, the initiation of appropriate respiratory support, assessment for the presence of concomitant acute coronary syndrome, and the rapid administration of medications aimed at reducing cardiac preload and afterload. Alternative medications and methods should be utilized for the symptomatic management of breathlessness, anxiety, and pain in these patients."