Yokota Junichi, Ogawa Yoshiko, Takahashi Yoshimi, Yamaguchi Nobuhiro, Onoue Noriko, Shinozaki Tsuyoshi, Kohzuki Masahiro
Department of Internal Medicine and Rehabilitation Science Disability Science, Tohoku University Graduate School of Medicine, 1-1, Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan.
Heart Vessels. 2020 Oct;35(10):1429-1438. doi: 10.1007/s00380-020-01617-w. Epub 2020 May 2.
Dysphagia, defined as a dysfunction in any stage or process of eating, is common in patients with acute exacerbation of heart failure (HF). In some diseases, dysphagia worsens in-hospital mortality, length of hospital stay, and discharge disposition. However, it remains unclear whether dysphagia is associated with poor short-term outcomes in HF patients. The objective of the present study was to determine whether dysphagia affects short-term outcomes in patients with acute exacerbation of HF. A total of 327 patients hospitalized with acute exacerbation of HF were eligible for the study. Patients were divided into a dysphagia group (DG) or a non-dysphagia group (NDG) based on results of the functional oral intake scale (FOIS), which evaluates a patient's ability of eating and swallowing. FOIS is a 7-point scale, with a level of ≤ 5 indicating dysphagia. Following the withdrawal of 16 patients, short-term outcomes such as in-hospital mortality, length of hospital stay, and discharge disposition, of 311 patients were analyzed. All indexes of short-term outcomes were significantly worse in the DG than in the NDG. After propensity score matching, which was performed to adjust for baseline characteristics such as age, sex, height, weight, body mass index, medical history, complications, HF severity, ejection fraction, and biochemical data excluding nutritional status, all short-term outcomes remained significantly worse in the DG than in the NDG. Multivariate analysis showed that FOIS was an independent predictor of in-hospital survival, length of hospital stay, and discharge to home. The present study suggested that dysphagia affected short-term outcomes in patients with acute exacerbation of HF. Therefore, early detection and intervention of dysphagia in HF patients are important.
吞咽困难被定义为进食的任何阶段或过程中的功能障碍,在心力衰竭(HF)急性加重患者中很常见。在某些疾病中,吞咽困难会增加住院死亡率、延长住院时间并影响出院处置。然而,吞咽困难是否与HF患者的短期不良结局相关仍不清楚。本研究的目的是确定吞咽困难是否会影响HF急性加重患者的短期结局。共有327例因HF急性加重住院的患者符合研究条件。根据功能性口服摄入量量表(FOIS)的结果,将患者分为吞咽困难组(DG)或无吞咽困难组(NDG),该量表用于评估患者的进食和吞咽能力。FOIS是一个7分制量表,≤5分表示吞咽困难。在排除16例患者后,对311例患者的住院死亡率、住院时间和出院处置等短期结局进行了分析。DG组的所有短期结局指标均显著差于NDG组。在进行倾向评分匹配以调整年龄、性别、身高、体重、体重指数、病史、并发症、HF严重程度、射血分数和排除营养状况的生化数据等基线特征后,DG组的所有短期结局仍显著差于NDG组。多变量分析表明,FOIS是住院生存率、住院时间和出院回家的独立预测因素。本研究表明,吞咽困难会影响HF急性加重患者的短期结局。因此,早期发现和干预HF患者的吞咽困难很重要。