While morphine has long been widely used in treating acute heart failure (AHF) due to its vasodilatory properties and anticipated anxiolysis, it remains unclear whether the application of morphine to those patients is reasonable. We aim to conduct a systematic review and meta-analysis to assess the safety of morphine in patients with AHF. We searched PubMed, Cochrane Library, and Embase electronic databases from inception through March 2020. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the outcomes. Seven studies with 172, 226 patients were included. The results showed that morphine usage was not associated with increased in-hospital mortality (OR: 1.94; 95% CI 0.93 to 4.03; p = 0.08). However, the use of morphine significantly increased the risk of invasive ventilation (OR: 2.72; 95% CI 1.09 to 6.80; p = 0.03). Furthermore, the subgroup analysis indicated that the application of morphine was not associated with increased 7-day all-cause mortality in patients with AHF (OR: 1.69; 95% CI 0.80 to 3.22; p = 0.11) but significantly increased the risk of 30-day all-cause mortality (OR: 1.59; 95% CI 1.16 to 2.17; p = 0.004). Based on current evidence, our results suggested that although morphine therapy did not significantly increase the risk of short-term death (in the hospital or within 7 days) in patients with AHF, the risk of long-term death and invasive ventilation were significantly increased. This result needs to be further confirmed by an ongoing randomized control trial.

中文翻译：

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急性心力衰竭患者使用吗啡的安全性：系统评价和荟萃分析

虽然吗啡因其血管舒张特性和预期的抗焦虑作用而长期被广泛用于治疗急性心力衰竭 (AHF)，但仍不清楚将吗啡应用于这些患者是否合理。我们旨在进行系统评价和荟萃分析，以评估吗啡在 AHF 患者中的安全性。我们检索了 PubMed、Cochrane 图书馆和 Embase 电子数据库，从开始到 2020 年 3 月。使用汇总优势比 (OR) 和 95% 置信区间 (CI) 来估计结果。包括 7 项研究，共 172 名，226 名患者。结果表明，使用吗啡与院内死亡率增加无关（OR：1.94；95% CI 0.93 至 4.03；p = 0.08）。然而，吗啡的使用显着增加了有创通气的风险（OR：2.72；95% CI 1.09 至 6.80；p  = 0.03）。此外，亚组分析表明，应用吗啡与 AHF 患者 7 天全因死亡率的增加无关（OR：1.69；95% CI 0.80 至 3.22；p  = 0.11），但显着增加了 30 - 天全因死亡率（OR：1.59；95% CI 1.16 至 2.17；p = 0.004）。基于目前的证据，我们的结果表明，虽然吗啡治疗并未显着增加 AHF 患者短期死亡（住院或 7 天内）的风险，但长期死亡和有创通气的风险显着增加. 这一结果需要通过正在进行的随机对照试验进一步证实。