Morphine Underused for End-of-Life Dyspnea in the Emergency Department Compared with Inpatient Care

A retrospective cohort study included 250 adults who presented to an ED in Israel with dyspnea between 2023 and 2024 and died during the same hospitalization (mean age, 83.2 years; 51.2% women; 91.5% Jewish individuals). Common underlying conditions included congestive heart failure, chronic obstructive pulmonary disease, and metastatic cancer.
Researchers assessed the proportion of patients receiving morphine in the ED and during the hospital stay.
Investigators evaluated the time to morphine administration, the respiratory support provided, and how long patients lived after arriving at the ED.
Predictors of ED morphine administration were identified using multivariable logistic regression.

Morphine was administered to 15.2% of patients in the ED but to 68% during inpatient care; among those treated in the ED, the average time to morphine administration was 5.8 hours.
Three factors independently predicted the use of morphine in the ED: lung cancer (odds ratio [OR], 3.41; P = .022), a do-not-resuscitate/do-not-intubate order (OR, 3.17; P = .010), and higher pulse rate at arrival (OR, 1.022 per beat increase; P = .008).
Morphine administration in the ED was not associated with time to death. Patients who received morphine during inpatient care had a longer observed mean survival than those who did not (282.2 vs 152.4 hours; P < .001); however, this comparison was subject to immortal time bias.

Blood Pressure Variability Linked to Mortality in Patients With ANCA-Associated Vasculitis Among patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis undergoing maintenance therapy, greater visit-to-visit systolic blood pressure variability (SBPV) was independently associated with an increased risk for all-cause mortality.

Morphine Underused for End-of-Life Dyspnea in the Emergency Department Compared with Inpatient Care Among 250 patients presenting to the emergency department (ED) with dyspnea at the end of life, 15.2% received morphine in the ED, whereas 68% received it during subsequent inpatient care. Patients with lung cancer or a do-not-resuscitate order were more likely to receive morphine in the ED, but its use was not associated with reduced survival.

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Cardiovascular Benefits of Semaglutide in SELECT Trial Not Fully Explained by Weight Loss and Other Improvements In adults with obesity and established cardiovascular disease (CVD), semaglutide was associated with improvements in several risk factors. However, those changes only accounted for part of the reduced risk for major adverse cardiovascular events (MACE) noted in the SELECT trial.

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