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BreatheMOR-HF: Morphine for breathlessness in heart failure

BreatheMOR-HF looked at whether prescribing slow release daily morphine tablets to individuals with heart failure helped with breathlessness. We were unable to answer the primary research question due to not reaching the required sample size. But we provided novel placebo-controlled medium-term benefit and safety data useful for clinical practice and future trial design.

Why did we do this research?

Some people with chronic heart failure experience breathlessness despite receiving medication. Persistent breathlessness is associated with poorer physical and mental quality of life, increased unplanned hospital attendance and higher mortality. In people with chronic breathlessness due to chronic obstructive pulmonary disease, regular, low dose, modified release morphine has been shown to be safe and effective in the short term. However, the evidence is less clear for those with chronic heart failure, although preliminary data suggests that these patients may benefit from morphine given for three months.

What did we do?

The trial was the first to provide placebo-controlled data for medium-duration, modified release, steady state, low dose, oral morphine for people with chronic breathlessness receiving guideline-recommended treatments for heart failure. We randomised 45 patients to receive either 10 milligram capsules of modified release morphine or placebo capsules identical in appearance, taste and smell. Patients were followed up for 12 weeks and data collected included average breathlessness, average pain, quality of life and opioid-relevant symptoms.

Who was involved?

Patients from England and Scotland were recruited from hospital/community cardiology or palliative care clinics or hospices. On average patients were 72 years old and 84% were male. 

What did we find?

We could not answer our primary objectives as we were unable to recruit sufficient participants. However, we provide novel placebo‐controlled medium‐term benefit and safety data useful for clinical practice and future trial design. 

Outputs

Johnson MJ, Cockayne S, Currow DC, Bell K, Hicks K, Fairhurst C, Gabe R, Torgerson D, Jefferson L, Oxberry S, Ghosh J. Oral modified release morphine for breathlessness in chronic heart failure: a randomized placebo‐controlled trial. ESC heart failure. 2019 Dec;6(6):1149-60. doi: 10.1002/ehf2.12498

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