Antipsychotic use and dysphagia risk in acute heart failure: a prospective cohort study

While antipsychotic drugs are known to induce dysphagia, their impact on patients with acute heart failure (AHF) remains largely unexplored. This study investigates the critical association between antipsychotic use and both swallowing and physical function in AHF patients. A prospective cohort study was conducted on hospitalized patients with AHF. We rigorously examined the relationship between antipsychotic drug use during hospitalization and outcomes at discharge. Antipsychotic drug use was defined as the regular administration of oral medication. The primary outcome was dysphagia, evaluated using the Food Intake Level Scale (FILS), with secondary outcomes including physical function (Barthel Index) and dysphagia incidence. We employed sophisticated statistical analyses, including multiple regression, logistic regression, and Cox proportional hazards models, adjusting for an extensive range of potential confounders to ensure robust results. Among 325 eligible patients (mean age 81.5 years, 53.2% female), our findings reveal a striking association between antipsychotic use and impaired swallowing function; with 34 patients (10.5%) in the antipsychotic drug use group. Antipsychotic users (34/325, 10.5% of cohort) showed significantly higher odds of dysphagia at discharge (OR = 7.724; 95% CI, 2.585-23.081, p < 0.001) and increased dysphagia incidence during hospitalization (HR = 1.635, 95% CI, 1.002-2.669, p  = 0.049). Notably, antipsychotic use was not associated with Barthel Index at discharge (β = 0.015; p = 0.658), suggesting a specific effect on swallowing function. This study provides compelling evidence that antipsychotic use in AHF patients is associated with a markedly increased risk of dysphagia.