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Reviews in Cardiovascular Medicine  2021, Vol. 22 Issue (3): 865-872     DOI: 10.31083/j.rcm2203092
Special Issue: State-of-the-Art Cardiovascular Medicine in Asia 2021
Systematic Review Previous articles | Next articles
Intravenous morphine use in acute heart failure increases adverse outcomes: a meta-analysis
Yaowang Lin1, 2, Yang Chen3, Jie Yuan1, 2, Xinli Pang1, 2, Huadong Liu1, 2, Shaohong Dong1, 2, *(), Qiuling Chen2, 4, *()
1Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, 518020 Shenzhen, Guangdong, China
2Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), 518020 Shenzhen, Guangdong, China
3School of Pharmacy, Guangdong Medical University, 523808 Dongguan, Guangdong, China
4Department of Pharmacy, Shenzhen People's Hospital, 518020 Shenzhen, Guangdong, China
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Intravenous morphine is a controversial treatment for acute heart failure (AHF). This study aimed to evaluate and compare the efficacy of intravenous morphine treatment vs. no morphine treatment in AHF patients. Relevant research conducted before June 2020 was retrieved from electronic databases. One unpublished study of our own was also included. Studies were eligible for inclusion if they compared AHF patients treated with intravenous morphine and patients who did not receive morphine. This meta-analysis included three propensity-matched cohorts and two retrospective analyses, involving a total of 149,967 patients (intravenous-morphine group, n = 22,072; no-morphine group, n = 127,895). There was a non-significant increase in the in-hospital mortality in the morphine group (combined odds ratio [OR] = 2.14, 95% confidence interval [CI]: 0.88–5.23, p = 0.095, I2 = 97.1%). However, subgroup analyse showed that the rate of in-hospital mortality with odds of 1.41 times more likely (95% CI: 1.11–1.80, p = 0.005, I2 = 0%) in those receiving vs. not receiving intravenous morphine. No significant correlation was found between intravenous morphine and invasive mechanical ventilation (OR = 2.19, 95% CI: 0.84–5.73, p = 0.10, I2 = 94.2%; subgroup analysis: OR = 2.24, 95% CI: 0.70–7.21, p = 0.176, I2 = 95.1%) or long-term mortality (hazard ratio = 1.15, 95% CI: 0.96–1.34, p = 0.335; I2 = 8.6%). The administration of intravenous morphine to patients with AHF may be related to in-hospital mortality, but not to invasive mechanical ventilation and long-term mortality.
Key words:  Intravenous morphine      Acute heart failure      In-hospital mortality      Mechanical ventilation      Long-term mortality     
Submitted:  07 June 2021      Revised:  22 July 2021      Accepted:  04 August 2021      Published:  24 September 2021     
SZXK003/Shenzhen Key Medical Discipline Construction Fund
SZXK059/Shenzhen Key Medical Discipline Construction Fund
SZSM201412012/Sanming Project of Medicine
*Corresponding Author(s): (Qiuling Chen); (Shaohong Dong)   

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Yaowang Lin, Yang Chen, Jie Yuan, Xinli Pang, Huadong Liu, Shaohong Dong, Qiuling Chen. Intravenous morphine use in acute heart failure increases adverse outcomes: a meta-analysis. Reviews in Cardiovascular Medicine, 2021, 22(3): 865-872.

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