Association of maximal tongue pressure with dysphagia and prognosis in patients with acute heart failure

Abstract

Background & aims: Although dysphagia is a highly prevalent complication in patients with acute heart failure (AHF), current AHF guidelines lack guidance on methods for assessing swallowing function. This study aimed to assess the impact of maximal tongue pressure on the occurrence of dysphagia and prognosis of patients with AHF.

Methods: This observational study conducted at a single center included 406 patients (mean age 79.4 ± 11.9 years, 170 women) with a diagnosis of AHF and without pre-admission dysphagia (Food Intake LEVEL Scale [FILS] ≥9). Patients were categorized into high tongue pressure group (≥20 kPa) and low tongue pressure group (<20 kPa) based on their maximal tongue pressure at admission. The analysis used the log-rank test and Cox proportional hazards model to examine FILS improvement and all-cause mortality. FILS improvement was defined as a FILS of ≥9 for the first-time during hospitalization.

Results: During the hospitalization period, 347 patients (85.5 %) experienced FILS improvement and 36 patients (8.9 %) died during a mean follow-up period of 7.5 ± 3.9 months. Survival analysis revealed that the low tongue pressure group, in comparison to the high tongue pressure group, exhibited notably poorer cumulative FILS improvement rate (log-rank: P < 0.001, adjusted hazard ratio [HR], 0.61; 95 % confidence interval [CI], 0.46-0.82; P = 0.001) and elevated cumulative mortality rate (log-rank: P < 0.001, adjusted HR, 2.38; 95%CI, 1.14-4.98 P = 0.021).

Conclusion: A decrease in maximal tongue pressure was correlated with an increased risk of developing dysphagia and all-cause mortality in patients with AHF.

Keywords: Acute disease; Deglutition disorder; Heart failure; Prognosis; Ultrasonography.