Profiling the Swallowing Safety and Efficiency of Patients Presenting With Congestive Heart Failure

Existing literature on dysphagia in patients with congestive heart failure (CHF) largely relies on patient-reported outcomes with limited instrumental data. This study aimed to objectively profile swallowing function in CHF patients using videofluroscopic swallow studies (VFSS) analyzed with the ASPEKT (Analysis of Swallowing Physiology: Events, Kinematics, and Timing) method.

We conducted a retrospective study of patients admitted with CHF at St. Michael's Hospital (2021-2023). VFSS of liquid boluses was rated with penetration-aspiration scale (PAS) and ASPEKT pixel-based measures by blinded raters. Logistic regression models identified predictors of swallowing safety and efficiency.

Twenty-five patients met inclusion criteria. Atypical swallowing safety was observed in 67% of patients with HFpEF and in 90% of patients with HFrEF (p = 0.39). Incomplete laryngeal vestibule closure (OR = 23.75, 95% CI [7.342, 76.829]) and thin liquids (OR = 5.578, 95% CI [1.477, 21.072]) were significantly associated with unsafe swallows, while a greater number of swallows was protective (OR = 1.657, 95% CI [1.085, 2.532]). Larger pharyngeal areas at maximum constriction were associated with increased residue (OR = 76.136, 95% CI [23.055, 251.421]), whereas thin (OR = 0.494, 95% CI [0.376, 0.649]) and mildly thick liquids (OR = 0.612, 95% CI [0.459, 0.818]) with reduced residue.

CHF may impair swallowing safety and efficiency, potentially through mechanisms similar to other pulmonary conditions. Prospective studies incorporating respiratory monitoring and stratifying by CHF severity are needed to clarify physiologic pathways and clinical risks.