Heart Rate as a Predictor of 6-Month Pneumonia Risk in Patients With Dysphagia

To determine whether resting heart rate (HR) or heart rate variability (HRV) derived from finger photoplethysmography (PPG) predicts 6-month pneumonia risk in patients with dysphagia. HRV reflects autonomic regulation of inflammation which may predispose to respiratory complications.

A total of 301 patients who underwent a videofluoroscopic swallow study (VFSS) in 2020-2021 were enrolled. Prior to VFSS, resting HR was measured using the CorSense HRV finger sensor (ELITE HRV). Additional HRV metrics, including the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences (RMSSD) were collected from a subset of 153 participants. Pneumonia incidence was assessed at 3 and 6 months through phone interviews and medical record review.

The mean age was 66.3 ± 12.5 years, and 38% were female. Twenty patients (7%) developed pneumonia, with 75% of cases occurring within 3 months. Patients who developed pneumonia had higher resting HR than those who did not (83.4 vs. 74.3 bpm, p < 0.01). This association remained significant after adjusting for age (p = 0.01). Pneumonia risk increased stepwise with higher HR thresholds, with a 2.4-fold greater risk observed at HR ≥ 82 bpm and a 2.8-fold risk at HR ≥ 90 bpm. HRV metrics were not significantly associated with pneumonia incidence.

Elevated resting HR, though within the normal range, was associated with increased pneumonia risk in patients with dysphagia. This may reflect underlying inflammation or autonomic dysfunction. Because comorbidities, medications, and VFSS severity were not accounted for, these findings should be interpreted as preliminary. Resting HR may represent a simple, non-invasive tool for pneumonia risk stratification in this population, but larger studies are needed for validation.

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