Morphine Use in the ED and Outcomes of Patients With Acute Heart Failure : A Propensity Score-Matching Analysis Based on the EAHFE Registry
Miró, Oscar (Hospital Clínic i Provincial de Barcelona)
Gil, Víctor (Hospital Clínic i Provincial de Barcelona)
Martín-Sánchez, Francisco Javier (Hospital Clínico San Carlos (Madrid))
Herrero-Puente, Pablo (Hospital Universitario Central de Asturias)
Jacob, Javier (Hospital Universitari de Bellvitge)
Mebazaa, Alexandre (Department of Anesthesiology and Critical Care Medicine. Hospital Lariboisière. Université Paris Diderot)
Harjola, Veli-Pekka (Emergency Medicine. Department of Emergency Medicine and Services. University of Helsinki. Helsinki University Hospital)
Ríos, José (Universitat Autònoma de Barcelona. Laboratori de Bioestadística i Epidemiologia)
Hollander, Judd E. (Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University)
Peacock, W. Frank (Department of Emergency Medicine, Baylor College of Medicine)
Llorens Soriano, Pere (Emergency Department. Hospital General de Alicante. University Miguel Hernández)

Fecha:	2017
Descripción:	12 pàg.
Resumen:	Objective The objective was to determine the relationship between short-term mortality and intravenous morphine use in ED patients who received a diagnosis of acute heart failure (AHF). Methods Consecutive patients with AHF presenting to 34 Spanish EDs from 2011 to 2014 were eligible for inclusion. The subjects were divided into those with (M) or without IV morphine treatment (WOM) groups during ED stay. The primary outcome was 30-day all-cause mortality, and secondary outcomes were mortality at different intermediate time points, in-hospital mortality, and length of hospital stay. We generated a propensity score to match the M and WOM groups that were 1:1 according to 46 different epidemiological, baseline, clinical, and therapeutic factors. We investigated independent risk factors for 30-day mortality in patients receiving morphine. Results We included 6,516 patients (mean age, 81 [SD, 10] years; 56% women): 416 (6. 4%) in the M and 6,100 (93. 6%) in the WOM group. Overall, 635 (9. 7%; M, 26. 7%; WOM, 8. 6%) died by day 30. After propensity score matching, 275 paired patients constituted each group. Patients receiving morphine had a higher 30-day mortality (55 [20. 0%] vs 35 [12. 7%] deaths; hazard ratio, 1. 66; 95% CI, 1. 09-2. 54; P =. 017). In patients receiving morphine, death was directly related to glycemia (P =. 013) and inversely related to the baseline Barthel index and systolic BP (P =. 021) at ED arrival (P =. 021). Mortality was increased at every intermediate time point, although the greatest risk was at the shortest time (at 3 days: 22 [8. 0%] vs 7 [2. 5%] deaths; OR, 3. 33; 95% CI, 1. 40-7. 93; P =. 014). In-hospital mortality did not increase (39 [14. 2%] vs 26 [9. 1%] deaths; OR, 1. 65; 95% CI, 0. 97-2. 82; P =. 083) and LOS did not differ between groups (median [interquartile range] in M, 8 [7]; WOM, 8 [6]; P =. 79). Conclusions This propensity score-matched analysis suggests that the use of IV morphine in AHF could be associated with increased 30-day mortality.
Ayudas:	Ministerio de Ciencia, Innovación y Universidades PI11/01021 Ministerio de Economía y Competitividad PI15/01019 Ministerio de Economía y Competitividad PI15/00773
Nota:	This study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from the Spanish Ministry of Health and FEDER (PI10/01918, PI11/01021, PI15/01019 and PI15/00773) and Fundació La Marató de TV3 (2015/2510). The Emergencies: processes and pathologies research group of the IDIBAPS receives financial support from the Catalonian Government for Consolidated Groups of Investigation (GRC 2009/1385 and 2014/0313).
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió acceptada per publicar
Materia:	Acute heart failure ; ED ; Morphine ; Opiates ; Outcome
Publicado en:	Chest, Vol. 152, Num. 4 (2017) , p. 821-832, ISSN 1931-3543

DOI: 10.1016/j.chest.2017.03.037
PMID: 28411112

30 p, 1.1 MB

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