{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:55:37Z","timestamp":1790736937703,"version":"4.1.0"},"reference-count":51,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T00:00:00Z","timestamp":1765238400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Pharm Health Care Sci"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The decision to administer opioids for dyspnea caused by heart failure should be made on an individual basis. However, factors associated with the effectiveness of opioids remain unclear, and information that could guide this decision is lacking. This study aimed to explore factors associated with the effectiveness of opioids to relieve dyspnea caused by heart failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective, multicenter, observational study included patients 18 years of age or older at the time of admission who received opioid administration (morphine, oxycodone, or hydromorphone) for dyspnea relief but did not receive invasive ventilatory support during hospitalization. Data were collected from the medical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 129 cases (30 ineffective cases, 80 effective cases, and 19 cases with missing dyspnea assessment data) were collected. The multivariable logistic regression analysis results indicated that the odds ratios of the New York Heart Association classification, number of diuretics used, and oxygen flow rate associated with the presence or absence of dyspnea improvement attributable to opioid administration were 0.496 (95% confidence interval, 0.254\u20130.967), 1.506 (95% confidence interval, 1.131\u20132.007), and 0.974 (95% confidence interval, 0.923\u20131.027), respectively. Trends in odds ratios for both the number of diuretics used and New York Heart Association classification were preserved in the multivariable logistic regression model that included factors that potentially influence dyspnea (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The effectiveness of opioids for relieving dyspnea caused by heart failure in hospitalized patients was positively associated with the number of diuretics used and negatively associated with the New York Heart Association classification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40780-025-00523-5","type":"journal-article","created":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T14:04:40Z","timestamp":1765289080000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Factors associated with the effectiveness of opioids for dyspnea in hospitalized patients with heart failure: a retrospective, multicenter, observational study"],"prefix":"10.1186","volume":"12","author":[{"given":"Shoichi","family":"Yoshikai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasushi","family":"Moriya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Yamada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Higuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emi","family":"Goto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masami","family":"Nishihara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Ashida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Ikeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"523_CR1","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1177\/0300060517718452","volume":"46","author":"S Yasobant","year":"2018","unstructured":"Yasobant S. Comprehensive public health action for our aging world: the quintessence of public health policy. J Int Med Res. 2018;46:555\u20136. https:\/\/journals.sagepub.com\/doi\/10.1177\/0300060517718452.","journal-title":"J Int Med Res"},{"key":"523_CR2","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.1253\/circj.CJ-19-0562","volume":"83","author":"I Komuro","year":"2019","unstructured":"Komuro I, Kaneko H, Morita H, Isobe M, Nakayama H, Minematsu K, et al. Nationwide actions against heart failure pandemic in Japan \u2013 what should we do from academia? Circ J. 2019;83:1819\u201321. https:\/\/www.jstage.jst.go.jp\/article\/circj\/83\/9\/83_CJ-19-0562\/_article.","journal-title":"Circ J"},{"key":"523_CR3","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1016\/j.jacc.2009.02.078","volume":"54","author":"SJ Goodlin","year":"2009","unstructured":"Goodlin SJ. Palliative care in congestive heart failure. J Am Coll Cardiol. 2009;54:386\u201396. https:\/\/doi.org\/10.1016\/j.jacc.2009.02.078.","journal-title":"J Am Coll Cardiol"},{"key":"523_CR4","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1056\/NEJMra1404684","volume":"373","author":"AS Kelley","year":"2015","unstructured":"Kelley AS, Morrison RS. Palliative care for the seriously ill. N Engl J Med. 2015;373:747\u201355. https:\/\/doi.org\/10.1056\/NEJMra1404684.","journal-title":"N Engl J Med"},{"key":"523_CR5","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","volume":"42","author":"TA McDonagh","year":"2021","unstructured":"McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, B\u00f6hm M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42:3599\u2013726. https:\/\/academic.oup.com\/eurheartj\/article\/42\/36\/3599\/6358045?login=false.","journal-title":"Eur Heart J"},{"key":"523_CR6","doi-asserted-by":"crossref","unstructured":"Kawaguchi J, Hamatani Y, Hirayama A, Nishimura K, Nakai E, Nakamura E et al. Experience of morphine therapy for refractory dyspnea as palliative care in advanced heart failure patients. J Cardiol. 2020;75:682-8. https:\/\/www.journal-of-cardiology.com\/article\/S0914-5087(20)30016-2\/fulltext.","DOI":"10.1016\/j.jjcc.2019.12.015"},{"key":"523_CR7","doi-asserted-by":"crossref","unstructured":"Johnson MJ, McDonagh TA, Harkness A, McKay SE, Dargie HJ. Morphine for the relief of breathlessness in patients with chronic heart failure\u2014a pilot study. Eur J Heart Fail. 2002;4:753\u20136. https:\/\/doi.org\/10.1016\/S1388-9842%2802%2900158-7.","DOI":"10.1016\/S1388-9842(02)00158-7"},{"key":"523_CR8","doi-asserted-by":"publisher","first-page":"529","DOI":"10.2512\/jspm.11.529","volume":"11","author":"K Ishii","year":"2016","unstructured":"Ishii K, Matsuo K, Ohno M, Muto S, Morishita S, Nagaishi E, et al. Continuous intravenous infusion of oxycodone for dyspnea from end stage-heart failure due to dilated cardiomyopathy. Palliat Care Res. 2016;11:529\u201333. https:\/\/www.jstage.jst.go.jp\/article\/jspm\/11\/2\/11_529\/_article\/-char\/ja\/.","journal-title":"Palliat Care Res"},{"key":"523_CR9","doi-asserted-by":"publisher","first-page":"2050313X2110374","DOI":"10.1177\/2050313X211037445","volume":"9","author":"T Nakamura","year":"2021","unstructured":"Nakamura T, Nakamura M, Shibasaki Y, Mizukami S, Tomita H, Hirai M, et al. Use of oral hydromorphone in a patient with stage D heart failure. SAGE Open Med Case Rep. 2021;9:2050313X211037445. https:\/\/doi.org\/10.1177\/2050313X211037445.","journal-title":"SAGE Open Med Case Rep"},{"key":"523_CR10","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1093\/eurjhf\/hfr068","volume":"13","author":"SG Oxberry","year":"2011","unstructured":"Oxberry SG, Torgerson DJ, Bland JM, Clark AL, Cleland JG, Johnson MJ. Short-term opioids for breathlessness in stable chronic heart failure: a randomized controlled trial. Eur J Heart Fail. 2011;13:1006\u201312. https:\/\/doi.org\/10.1093\/eurjhf\/hfr068.","journal-title":"Eur J Heart Fail"},{"key":"523_CR11","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1136\/heartjnl-2022-322074","volume":"109","author":"J Gaertner","year":"2023","unstructured":"Gaertner J, Fusi-Schmidhauser T, Stock S, Siemens W, Vennedey V. Effect of opioids for breathlessness in heart failure: a systematic review and meta-analysis. Heart. 2023;109:1064\u201371. https:\/\/heart.bmj.com\/content\/109\/14\/1064.","journal-title":"Heart"},{"key":"523_CR12","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1002\/ejhf.289","volume":"17","author":"A Mebazaa","year":"2015","unstructured":"Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S, et al. Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the heart failure association of the European society of Cardiology, the European society of emergency medicine and the society of academic emergency medicine. Eur J Heart Fail. 2015;17:544\u201358. https:\/\/doi.org\/10.1002\/ejhf.289.","journal-title":"Eur J Heart Fail"},{"key":"523_CR13","doi-asserted-by":"crossref","unstructured":"Johnson MJ, Abernethy AP, Currow DC. Gaps in the evidence base of opioids for refractory breathlessness. A future work plan? J Pain Symptom Manage. 2012;43:614\u201324. https:\/\/www.jpsmjournal.com\/article\/S0885-3924(11)00513-6\/fulltext.","DOI":"10.1016\/j.jpainsymman.2011.04.024"},{"key":"523_CR14","unstructured":"The Ministry of Health, Labour, and, Welfare J. Special functioning hospitals regional medical care support hospitals (since 1997). 2025. Available from: https:\/\/www.mhlw.go.jp\/english\/wp\/wp-hw2\/part2\/p3_0006.pdf. [Accessed 2025 11 Jan]."},{"key":"523_CR15","first-page":"168","volume":"25","author":"K Chin","year":"2015","unstructured":"Chin K. Oxygen therapy and noninvasive ventilation. J Jp Soc Resp Care Rehab. 2015;25:168\u201373. https:\/\/www.jstage.jst.go.jp\/article\/jsrcr\/25\/2\/25_168\/_article\/-char\/ja\/.","journal-title":"J Jp Soc Resp Care Rehab"},{"key":"523_CR16","doi-asserted-by":"publisher","first-page":"977","DOI":"10.6004\/jnccn.2019.0038","volume":"17","author":"RA Swarm","year":"2019","unstructured":"Swarm RA, Paice JA, Anghelescu DL, Are M, Bruce JY, Buga S, et al. Adult cancer pain, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2019;17:977\u20131007. https:\/\/jnccn.org\/view\/journals\/jnccn\/17\/8\/article-p977.xml.","journal-title":"J Natl Compr Canc Netw"},{"key":"523_CR17","first-page":"1","volume":"14","author":"T Maeda","year":"2021","unstructured":"Maeda T, Hayakawa T. Corticosteroid administration to cancer patients with dyspnea and changes in support team assessment schedule Japanese version (STAS-J) score. Jpn J Pharm Palliat Care Sci. 2021;14:1\u20135. https:\/\/jpps.umin.jp\/14_01-2\/.","journal-title":"Jpn J Pharm Palliat Care Sci"},{"key":"523_CR18","unstructured":"Japan Hospice Palliative Care Foundation, Japan. Japanese version of the support team assessment schedule (STAS-J) Scoring Manual, 3rd Edition. 2025. https:\/\/plaza.umin.ac.jp\/stas\/stas_manualv3.pdf. Accessed 11 Jan 2025."},{"key":"523_CR19","doi-asserted-by":"crossref","unstructured":"Miyashita M, Matoba K, Sasahara T, Kizawa Y, Maruguchi M, Abe M et al. The reliability and validity of the Japanese version of the Support Team Assessment Schedule (STAS-J). Palliat Support Care. 2004;2:379\u2009\u2013\u200985. https:\/\/www.cambridge.org\/core\/journals\/palliative-and-supportive-care\/article\/abs\/reliability-and-validity-of-the-japanese-version-of-the-support-team-assessment-schedule-stasj\/B47D90AD2F46D44343E9EC8119ADC45E.","DOI":"10.1017\/S1478951504040507"},{"key":"523_CR20","doi-asserted-by":"publisher","first-page":"2126","DOI":"10.1016\/S0140-6736(00)03492-9","volume":"356","author":"J Masip","year":"2000","unstructured":"Masip J, Betbes\u00e9 AJ, P\u00e1ez J, Vecilla F, Ca\u00f1izares R, Padr\u00f3 J, et al. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomised trial. Lancet. 2000;356:2126\u201332. https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(00)03492-9\/abstract.","journal-title":"Lancet"},{"key":"523_CR21","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1097\/CM9.0000000000002227","volume":"136","author":"S Yang","year":"2023","unstructured":"Yang S, He Y, Liu S, Zhang Y. High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to non-invasive mechanical ventilation in reducing intubation rate in hypoxia and dyspnea due to acute heart failure: a systematic review and meta-analysis. Chin Med J (Engl). 2023;136:479\u201381. https:\/\/journals.lww.com\/cmj\/fulltext\/2023\/02200\/high_flow_nasal_cannula_oxygen_therapy_is_superior.13.aspx.","journal-title":"Chin Med J (Engl)"},{"key":"523_CR22","doi-asserted-by":"crossref","unstructured":"Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373-9. https:\/\/www.jclinepi.com\/article\/S0895-4356(96)00236-3\/abstract.","DOI":"10.1016\/S0895-4356(96)00236-3"},{"key":"523_CR23","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1111\/tri.12895","volume":"30","author":"G Heinze","year":"2017","unstructured":"Heinze G, Dunkler D. Five Myths about variable selection. Transpl Int. 2017;30:6\u201310. https:\/\/doi.org\/10.1111\/tri.12895.","journal-title":"Transpl Int"},{"key":"523_CR24","doi-asserted-by":"crossref","unstructured":"Greenland S, Mansournia MA, Altman DG. Sparse data bias: a problem hiding in plain sight. BMJ. 2016;352:i1981. https:\/\/www.bmj.com\/content\/352\/bmj.i1981.","DOI":"10.1136\/bmj.i1981"},{"key":"523_CR25","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1093\/eurheartj\/ehac689","volume":"44","author":"JC Trull\u00e0s","year":"2023","unstructured":"Trull\u00e0s JC, Morales-Rull JL, Casado J, Carrera-Izquierdo M, S\u00e1nchez-Marteles M, Conde-Martel A, et al. Combining loop with Thiazide diuretics for decompensated heart failure: the CLOROTIC trial. Eur Heart J. 2023;44:411\u201321. https:\/\/academic.oup.com\/eurheartj\/article\/44\/5\/411\/6845636?login=false.","journal-title":"Eur Heart J"},{"key":"523_CR26","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1016\/j.cardfail.2016.02.007","volume":"22","author":"Y Matsue","year":"2016","unstructured":"Matsue Y, Suzuki M, Torii S, Yamaguchi S, Fukamizu S, Ono Y, et al. Clinical effectiveness of Tolvaptan in patients with acute heart failure and renal dysfunction. J Card Fail. 2016;22:423\u201332. https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1071916416000671.","journal-title":"J Card Fail"},{"key":"523_CR27","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1253\/circj.cj-25-0002","volume":"89","author":"T Kitai","year":"2025","unstructured":"Kitai T, Kohsaka S, Kato T, Kato E, Sato K, Teramoto K, et al. JCS\/JHFS 2025 guideline on diagnosis and treatment of heart failure. Circ J. 2025;89:1278\u2013444. https:\/\/doi.org\/10.1253\/circj.cj-25-0002.","journal-title":"Circ J"},{"key":"523_CR28","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1016\/0014-2999(91)90170-u","volume":"209","author":"BJ Van de Heijning","year":"1991","unstructured":"Van de Heijning BJ, Koekkoek-Van den Herik I, Van Wimersma Greidanus TB. The opioid receptor subtypes mu and kappa, but not delta, are involved in the control of the vasopressin and Oxytocin release in the rat. Eur J Pharmacol. 1991;209:199\u2013206. https:\/\/doi.org\/10.1016\/0014-2999(91)90170-u.","journal-title":"Eur J Pharmacol"},{"key":"523_CR29","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1161\/circheartfailure.112.970012","volume":"6","author":"DE Lanfear","year":"2013","unstructured":"Lanfear DE, Sabbah HN, Goldsmith SR, Greene SJ, Ambrosy AP, Fought AJ, et al. Association of arginine vasopressin levels with outcomes and the effect of V2 Blockade in patients hospitalized for heart failure with reduced ejection fraction: insights from the EVEREST trial. Circ Heart Fail. 2013;6:47\u201352. https:\/\/doi.org\/10.1161\/circheartfailure.112.970012.","journal-title":"Circ Heart Fail"},{"key":"523_CR30","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/S0025-7125(16)36724-4","volume":"24","author":"LJ Boyd","year":"1940","unstructured":"Boyd LJ, Scherf D. The effect of sedatives on diuresis. Med Clin North Am. 1940;24:869\u201376. https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0025712516367244.","journal-title":"Med Clin North Am"},{"key":"523_CR31","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1136\/hrt.29.5.709","volume":"29","author":"I Singh","year":"1967","unstructured":"Singh I, Lal M, Khanna PK, Mathew NT. Augmentation of Frusemide diuresis by morphine in high altitude pulmonary oedema. Br Heart J. 1967;29:709\u201313. https:\/\/doi.org\/10.1136\/hrt.29.5.709.","journal-title":"Br Heart J"},{"key":"523_CR32","unstructured":"Ancaron\u00ae Injection package insert. 2025. https:\/\/pins.japic.or.jp\/pdf\/newPINS\/00052966.pdf. Accessed 27 Jul 2025."},{"key":"523_CR33","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1089\/jpm.2007.9912","volume":"10","author":"DC Currow","year":"2007","unstructured":"Currow DC, Plummer J, Frith P, Abernethy AP. Can we predict which patients with refractory dyspnea will respond to opioids? J Palliat Med. 2007;10:1031\u20136. https:\/\/doi.org\/10.1089\/jpm.2007.9912.","journal-title":"J Palliat Med"},{"key":"523_CR34","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.jpainsymman.2013.05.006","volume":"47","author":"MJ Johnson","year":"2014","unstructured":"Johnson MJ, Bland JM, Davidson PM, Newton PJ, Oxberry SG, Abernethy AP, et al. The relationship between two performance scales: new York heart association classification and Karnofsky performance status scale. J Pain Symptom Manage. 2014;47:652\u20138. https:\/\/doi.org\/10.1016\/j.jpainsymman.2013.05.006.","journal-title":"J Pain Symptom Manage"},{"key":"523_CR35","doi-asserted-by":"publisher","first-page":"1328","DOI":"10.1016\/0959-8049(92)90510-9","volume":"28A","author":"E Verger","year":"1992","unstructured":"Verger E, Salamero M, Conill C. Can Karnofsky performance status be transformed to the Eastern cooperative oncology group scoring scale and vice versa? Eur J Cancer. 1992;28A:1328\u201330. https:\/\/doi.org\/10.1016\/0959-8049(92)90510-9.","journal-title":"Eur J Cancer"},{"key":"523_CR36","doi-asserted-by":"publisher","first-page":"201","DOI":"10.17727\/JMSR.2022\/10-37","volume":"10","author":"B Singh","year":"2022","unstructured":"Singh B, Rao RV. Albumin and its association with lung cancer: an Indian perspective. J Med Sci Res. 2022;10:201\u20135. https:\/\/jmsronline.com\/archive-article\/Albumin-association-lung-cancer-Indian-perspective.","journal-title":"J Med Sci Res"},{"key":"523_CR37","doi-asserted-by":"publisher","first-page":"e24785","DOI":"10.1097\/md.0000000000024785","volume":"100","author":"M El Iskandarani","year":"2021","unstructured":"El Iskandarani M, El Kurdi B, Murtaza G, Paul TK, Refaat MM. Prognostic role of albumin level in heart failure: A systematic review and meta-analysis. Med (Baltim). 2021;100:e24785. https:\/\/doi.org\/10.1097\/md.0000000000024785.","journal-title":"Med (Baltim)"},{"key":"523_CR38","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1001\/jamacardio.2021.0372","volume":"6","author":"SJ Greene","year":"2021","unstructured":"Greene SJ, Butler J, Spertus JA, Hellkamp AS, Vaduganathan M, DeVore AD, et al. Comparison of new York heart association class and Patient-Reported outcomes for heart failure with reduced ejection fraction. JAMA Cardiol. 2021;6:522\u201331. https:\/\/doi.org\/10.1001\/jamacardio.2021.0372.","journal-title":"JAMA Cardiol"},{"key":"523_CR39","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1055\/s-0031-1284434","volume":"20","author":"AM Alvarez","year":"2011","unstructured":"Alvarez AM, Mukherjee D. Liver abnormalities in cardiac diseases and heart failure. Int J Angiol. 2011;20:135\u201342. https:\/\/doi.org\/10.1055\/s-0031-1284434.","journal-title":"Int J Angiol"},{"key":"523_CR40","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/s0304-3959(97)00142-5","volume":"74","author":"CC Faura","year":"1998","unstructured":"Faura CC, Collins SL, Moore AR, McQuay HJ. Systematic review of factors affecting the ratios of morphine and its major metabolites. Pain. 1998;74:43\u201353. https:\/\/doi.org\/10.1016\/s0304-3959(97)00142-5.","journal-title":"Pain"},{"key":"523_CR41","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","volume":"37","author":"P Ponikowski","year":"2016","unstructured":"Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European society of cardiology (ESC) developed with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J. 2016;37:2129\u2013200. https:\/\/doi.org\/10.1093\/eurheartj\/ehw128.","journal-title":"Eur Heart J"},{"key":"523_CR42","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1093\/eurheartj\/ehi044","volume":"26","author":"MS Nieminen","year":"2005","unstructured":"Nieminen MS, B\u00f6hm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, et al. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the task force on acute heart failure of the European society of cardiology. Eur Heart J. 2005;26:384\u2013416. https:\/\/doi.org\/10.1093\/eurheartj\/ehi044.","journal-title":"Eur Heart J"},{"key":"523_CR43","doi-asserted-by":"publisher","first-page":"933","DOI":"10.1016\/j.ejheart.2008.08.005","volume":"10","author":"K Dickstein","year":"2008","unstructured":"Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European society of Cardiology. Developed in collaboration with the heart failure association of the ESC (HFA) and endorsed by the European society of intensive care medicine (ESICM). Eur J Heart Fail. 2008;10:933\u201389. https:\/\/doi.org\/10.1016\/j.ejheart.2008.08.005.","journal-title":"Eur J Heart Fail"},{"key":"523_CR44","doi-asserted-by":"publisher","first-page":"2157","DOI":"10.1253\/circj.CJ-66-0068","volume":"77","author":"JCS Joint Working Group","year":"2013","unstructured":"JCS Joint Working Group. Guidelines for treatment of acute heart failure (JCS 2011). Circ J. 2013;77:2157\u2013201. https:\/\/doi.org\/10.1253\/circj.CJ-66-0068.","journal-title":"Circ J"},{"key":"523_CR45","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1253\/circj.CJ-19-0342","volume":"83","author":"H Tsutsui","year":"2019","unstructured":"Tsutsui H, Isobe M, Ito H, Ito H, Okumura K, Ono M, et al. JCS 2017\/JHFS 2017 guideline on diagnosis and treatment of acute and chronic heart Failure\u3000- digest version. Circ J. 2019;83:2084\u2013184. https:\/\/doi.org\/10.1253\/circj.CJ-19-0342.","journal-title":"Circ J"},{"key":"523_CR46","doi-asserted-by":"publisher","first-page":"1404","DOI":"10.1253\/circj.CJ-21-0431","volume":"27","author":"H Tsutsui","year":"2021","unstructured":"Tsutsui H, Ide T, Ito H, Kihara Y, Kinugawa K, Kinugawa S, et al. JCS\/JHFS 2021 guideline focused update on diagnosis and treatment of acute and chronic heart failure. J Card Fail. 2021;27:1404\u201344. https:\/\/doi.org\/10.1253\/circj.CJ-21-0431.","journal-title":"J Card Fail"},{"key":"523_CR47","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1093\/eurjhf\/hfp041","volume":"11","author":"T Jaarsma","year":"2009","unstructured":"Jaarsma T, Beattie JM, Ryder M, Rutten FH, McDonagh T, Mohacsi P, et al. Advanced heart failure study group of the HFA of the ESC. Palliative care in heart failure: a position statement from the palliative care workshop of the heart failure association of the European society of cardiology. Eur J Heart Fail. 2009;11:433\u201343. https:\/\/doi.org\/10.1093\/eurjhf\/hfp041.","journal-title":"Eur J Heart Fail"},{"key":"523_CR48","unstructured":"Japan Health Policy NOW, Health Insurance System. 2025. Available from: https:\/\/japanhpn.org\/en\/hs1\/. [Accessed 2025 18 May]."},{"key":"523_CR49","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1093\/eurheartj\/ehs444","volume":"34","author":"AP Ambrosy","year":"2013","unstructured":"Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B, et al. Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the everest trial. Eur Heart J. 2013;34:835\u201343. https:\/\/doi.org\/10.1093\/eurheartj\/ehs444.","journal-title":"Eur Heart J"},{"key":"523_CR50","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1111\/j.1365-2702.2004.00816.x","volume":"13","author":"L Nordgren","year":"2004","unstructured":"Nordgren L, Olsson H. Palliative care in a coronary care unit: a qualitative study of physicians\u2019 and nurses\u2019 perceptions. J Clin Nurs. 2004;13:185\u201393. https:\/\/doi.org\/10.1111\/j.1365-2702.2004.00816.x.","journal-title":"J Clin Nurs"},{"key":"523_CR51","doi-asserted-by":"publisher","first-page":"2395","DOI":"10.21037\/tlcr-22-512","volume":"11","author":"Y Taniguchi","year":"2022","unstructured":"Taniguchi Y, Matsuda Y, Mori M, Ito M, Ikari T, Tokoro A, et al. Effectiveness and safety of opioids for dyspnea in patients with lung cancer: secondary analysis of multicenter prospective observational study. Transl Lung Cancer Res. 2022;11:2395\u2013402. https:\/\/doi.org\/10.21037\/tlcr-22-512.","journal-title":"Transl Lung Cancer Res"}],"container-title":["Journal of Pharmaceutical Health Care and Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40780-025-00523-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40780-025-00523-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40780-025-00523-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:12:38Z","timestamp":1781622758000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40780-025-00523-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,9]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["523"],"URL":"https:\/\/doi.org\/10.1186\/s40780-025-00523-5","relation":{},"ISSN":["2055-0294"],"issn-type":[{"value":"2055-0294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,9]]},"assertion":[{"value":"25 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by The University of Osaka Hospital Ethical Review Board (approval number: 23215(T3); approval date: October 6, 2023). As this was a retrospective observational study, the Ethical Review Board approved its conduct using an opt-out approach and waived the requirement for individual informed consent. It was conducted after providing individuals with an opportunity to withdraw consent by posting an opt-out document on the websites of The University of Osaka Hospital Pharmacy, Kurashiki Central Hospital Pharmacy, and Osaka Medical and Pharmaceutical University Hospital Pharmacy.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6"}}