In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to HFA Silver & Gold Members, Fellows of the ESC and Young combined Members

Adverse Dose Dependent Effects of Morphine Therapy in Acute Heart Failure

Session Moderated Poster Session - Acute heart failure

Speaker Oren Caspi

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure: Pharmacotherapy
  • Session type : Moderated Posters

Authors : O Caspi (Haifa,IL), NR Naami (Haifa,IL), EA Halfin (Haifa,IL), DA Aronson (Haifa,IL)

O Caspi1 , NR Naami2 , EA Halfin2 , DA Aronson1 , 1Rambam Health Care Campus, Cardiology - Haifa - Israel , 2Technion - Israel Institute of Technology - Haifa - Israel ,


Aims: Morphine has been a pivotal therapy in acute heart failure (AHF) for more than a century. The evidence for morphine therapy in AHF remains controversial. This study sought to assess the therapeutic effect of morphine on patients with AHF.

Methods and Results: The study used a cohort of 13,788 patients admitted with a primary diagnosis of AHF. Propensity-score-matching was generated using 26 clinical variables. Primary endpoints included in-hospital mortality and invasive mechanical ventilation. Secondary endpoints included non-invasive ventilation, need for inotropes and acute kidney injury (AKI). 761 (5.5%) patients were treated with morphine in the first day following hospital admission. Propensity score matching yielded 672 patient pairs. The incidence of invasive ventilation was higher in the morphine-treated patients (7.4%) than in matched patients in the no-morphine cohort (3.6%), OR 2.13 (95% CI 1.32-3.57, P=0.007).  In-hospital mortality was also higher in the morphine group (17.4%) than in the matched no-morphine group (13.4%), OR 1.43 (95% CI 1.05 to 1.98, P=0.024). For both the endpoint of invasive ventilation (Ptrend=0.005) and mortality (Ptrend=0.004), there was a significant linear dose-response relationship for the adverse effect of morphine. Morphine was associated with a significant increase in all secondary outcomes: Non-invasive ventilation (OR 2.78, 95% CI 1.95–3.96); Inotrope use (OR 3.50, 95% CI 2.10–5.82) and AKI (OR 1.81, 95% CI 1.39–2.36). A landmark analysis demonstrated no difference in post-discharge survival between cohorts. Conclusions: Morphine administration in is associated with significant dose-dependent risk for in-hospital mortality and need for mechanical ventilation.

Members get more

Join now
  • 1ESC Professional Members – access all resources from general ESC events 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are