Objectives Morphine is effective in alleviating dyspnoea in patients with cancer. We aimed to investigate the effectiveness and safety of morphine administration for refractory dyspnoea in patients with advanced heart failure (HF).
Methods We conducted a multicentre, prospective, observational study of hospitalised patients with advanced HF in whom morphine was administered for refractory dyspnoea. Morphine effectiveness was evaluated by dyspnoea intensity changes, assessed regularly by both a quantitative subjective scale (Visual Analogue Scale (VAS; graded from 0 to 100 mm)) and an objective scale (Support Team Assessment Schedule—Japanese (STAS-J; graded from 0 to 4 points)). Safety was assessed by vital sign changes and new-onset severe adverse events, including nausea, vomiting, constipation and delirium based on the Common Terminology Criteria for Adverse Events.
Results From 15 Japanese institutions between September 2020 and August 2022, we included 28 hospitalised patients with advanced HF in whom morphine was administered (mean age: 83.8±8.7 years, male: 15 (54%), New York Heart Association class IV: 26 (93%) and mean left ventricular ejection fraction: 38%±19%). Both VAS and STAS-J significantly improved from baseline to day 1 (VAS: 67±26 to 50±31 mm; p=0.02 and STAS-J: 3.3±0.8 to 2.6±1.1 points; p=0.006, respectively), and thereafter the improvements sustained through to day 7. After morphine administration, vital signs including blood pressure, pulse rate and oxygen saturation did not change, and no new-onset severe adverse events occurred through to day 7.
Conclusions This study suggested acceptable effectiveness and safety for morphine administration in treating refractory dyspnoea in hospitalised patients with advanced HF.
- Heart failure
- quality of life
Data availability statement
Data are available upon reasonable request.
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Contributors YH, YY, HY and MA were involved in the conception and study design. MI, KM, YAn, YI, RN, KS, HK, HM, YY, KTaka, KTake, KK, YK, RM, HY, KN, MK and YAo were involved in the data collection process. YH cleaned and analysed the data. YH and MI prepared the original draft. TKit, YS, TKim and MA supervised the original draft. All authors contributed to reviewing and editing the final draft. YH is the guarantor of the content.
Funding This study was supported by JSPS KAKENHI (Grant Number JP20K17169) (YH).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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