Juri Kawaguchi1, Yasuhiro Hamatani2, Atsushi Hirayama3, Kunihiro Nishimura4, Eri Nakai5, Emi Nakamura6, Michi Miyata6, Yukie Kawano7, Yasuko Takada7, Yuta Anchi3, Sayaka Funabashi3, Kensuke Kuroda3, Michiyo Azechi8, Hiroyuki Takahama3, Toshihisa Anzai9, Satoshi Yasuda3, Hiroaki Kitaoka10, Chisato Izumi11. 1. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan. 2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 3. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. 4. Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan. 5. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Division of Cardiology, Department of Medicine II, Kansai Medical University, Osaka, Japan. 6. Department of Pharmacy, National Cerebral and Cardiovascular Center, Osaka, Japan. 7. Department of Nursing, National Cerebral and Cardiovascular Center, Osaka, Japan. 8. Department of Psychiatry, National Cerebral and Cardiovascular Center, Osaka, Japan. 9. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Hokkaido, Japan. 10. Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan. 11. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: izumi-ch@ncvc.go.jp.
Abstract
BACKGROUND: In the field of palliative care, morphine is known to be effective for alleviating dyspnea in cancer patients. However, little is known regarding the safety and efficacy of morphine therapy for refractory dyspnea as palliative care in advanced heart failure (HF) patients. METHODS: We retrospectively reviewed consecutive advanced HF patients who were referred to the Palliative Care Team at our institution and administered morphine for refractory dyspnea during hospitalization between September 2013 and December 2018. We investigated the details of morphine usage, vital signs, an 11-point quantitative symptom scale, and adverse events at baseline, 24 h, and 72 h after the start of treatment. RESULTS: Morphine was administered for refractory dyspnea in 43 advanced HF patients [mean age: 73.5 years, male: 28 (65%), New York Heart Association functional class IV: 43 (100%), median left ventricular ejection fraction: 25%, median B-type natriuretic peptide level: 927 pg/ml, concurrent intravenous inotrope: 33 (77%)]. Median initial dose of morphine was 5 mg/day in both oral and intravenous administration and median duration of administration was 5 days. Significant decreases in an 11-point quantitative symptom scale [7 (5, 9) vs. 2 (1, 6); p < 0.01, (data available in 8 patients)] and respiratory rate (22.2 ± 6.1 vs. 19.7 ± 5.2 breaths per minute; p < 0.01) were observed 24 h after the start of morphine administration. Meanwhile, oxygen saturation, blood pressure, and heart rate were not significantly altered after treatment (NS). Common adverse events were delirium (18%) and constipation (8%); however, no lethal adverse event definitely related to morphine therapy occurred during treatment. CONCLUSIONS: This single-center retrospective study revealed the clinical practice of morphine therapy and suggested that morphine therapy might be feasible for refractory dyspnea as palliative care in advanced HF patients.
BACKGROUND: In the field of palliative care, morphine is known to be effective for alleviating dyspnea in cancerpatients. However, little is known regarding the safety and efficacy of morphine therapy for refractory dyspnea as palliative care in advanced heart failure (HF) patients. METHODS: We retrospectively reviewed consecutive advanced HFpatients who were referred to the Palliative Care Team at our institution and administered morphine for refractory dyspnea during hospitalization between September 2013 and December 2018. We investigated the details of morphine usage, vital signs, an 11-point quantitative symptom scale, and adverse events at baseline, 24 h, and 72 h after the start of treatment. RESULTS:Morphine was administered for refractory dyspnea in 43 advanced HFpatients [mean age: 73.5 years, male: 28 (65%), New York Heart Association functional class IV: 43 (100%), median left ventricular ejection fraction: 25%, median B-type natriuretic peptide level: 927 pg/ml, concurrent intravenous inotrope: 33 (77%)]. Median initial dose of morphine was 5 mg/day in both oral and intravenous administration and median duration of administration was 5 days. Significant decreases in an 11-point quantitative symptom scale [7 (5, 9) vs. 2 (1, 6); p < 0.01, (data available in 8 patients)] and respiratory rate (22.2 ± 6.1 vs. 19.7 ± 5.2 breaths per minute; p < 0.01) were observed 24 h after the start of morphine administration. Meanwhile, oxygen saturation, blood pressure, and heart rate were not significantly altered after treatment (NS). Common adverse events were delirium (18%) and constipation (8%); however, no lethal adverse event definitely related to morphine therapy occurred during treatment. CONCLUSIONS: This single-center retrospective study revealed the clinical practice of morphine therapy and suggested that morphine therapy might be feasible for refractory dyspnea as palliative care in advanced HFpatients.