Evidence map›Paper›PMID 28411112›Full record

Observational studyChest2017

Morphine Use in the ED and Outcomes of Patients With Acute Heart Failure: A Propensity Score-Matching Analysis Based on the EAHFE Registry.

Òscar Miró, Víctor Gil, Francisco J Martín-Sánchez, Pablo Herrero-Puente, Javier Jacob, Alexandre Mebazaa, Veli-Pekka Harjola, José Ríos, Judd E Hollander, W Frank Peacock and 2 more

Open access · greenAbstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Chest, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
15citing papers in PubMed, 3 pooled it
4.8field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

15 citing papers in PubMed, 3 syntheses or guidelines pooled it, 53 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Trial
  5. Article
  6. Introducing palliative care into the management of patients disqualified from transcatheter aortic valve implantation.Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery · 2026
    Review
  7. Article
  8. Review
  9. Review
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  11. Review
  12. Article
  13. Morphine in acute heart failure.Journal of thoracic disease · 2017
    Article
  14. Article
  15. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 11 institutions in 4 countries.

Òscar MiróEmergency Department, Hospital Clínic, Barcelona, Spain. Electronic address: omiro@clinic.cat.
Víctor GilEmergency Department, Hospital Clínic, Barcelona, Spain.
Francisco J Martín-SánchezEmergency Department, Hospital Clínico San Carlos, Madrid, Universidad Complutense de Madrid, Spain.
Pablo Herrero-PuenteEmergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
Javier JacobEmergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Alexandre MebazaaDepartment of Anesthesiology and Critical Care Medicine, Hospital Lariboisière, Université Paris Diderot, Paris, France.
Veli-Pekka HarjolaEmergency Medicine, Helsinki University, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
José RíosLaboratory of Biostatistics & Epidemiology, Universitat Autonoma de Barcelona; Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain.
Judd E HollanderDepartment of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
W Frank PeacockDepartment of Emergency Medicine, Baylor College of Medicine, Houston, TX.
Pere LlorensEmergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain.
ICA-SEMES Research Group(∗)
Universitat Autònoma de Barcelona · ESHospital Clínic de Barcelona · ESBellvitge University Hospital · ESHospital Clínico San Carlos · ESUniversité Paris Cité · FRBaylor College of Medicine · USHelsinki University Hospital · FIHospital General Universitario de Alicante Doctor Balmis · ESHospital Universitario Central de Asturias · ESThomas Jefferson University · USUniversidad Complutense de Madrid · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe 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).

methodsConsecutive 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.

resultsWe 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).

conclusionsThis propensity score-matched analysis suggests that the use of IV morphine in AHF could be associated with increased 30-day mortality.

Indexed as

Propensity ScoreRegistriesRisk AssessmentAcute DiseaseAged, 80 and overEmergency Service, HospitalFemaleHeart FailureHemodynamicsHospital MortalityHumansInjections, IntravenousLength of StayMaleMorphineNarcoticsMorphineNarcoticsacute heart failureEDmorphineopiatesoutcome

Identifiers

PMID28411112
OpenAlexW2605860125

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.