Mechanisms, outcomes, and management of heart failure-associated dysphagia: a scoping review - revised marked

More than 20% of patients with heart failure (HF) experience dysphagia, or difficulty swallowing. Although a previous review identified several risk factors and highlighted the bidirectional relationship between dysphagia and sarcopenia, it focused primarily on older hospitalized adults, leaving important knowledge gaps across the broader HF population.

A scoping review was conducted using four electronic databases: PubMed, CINAHL, Embase, and Google Scholar, to identify studies involving adult patients with HF and dysphagia. No restrictions were placed on publication date, study duration, or geographical region.

Thirty-six articles met the inclusion criteria. Key mechanisms of HF-associated dysphagia (HFAD) included cardiomegaly-induced esophageal compression, esophageal dysmotility, and stricture formation. HFAD was associated with adverse outcomes, including dehydration, malnutrition, aspiration, prolonged hospitalization, non-home discharge, and mortality. Reported risk factors included advanced age, systemic inflammation, poor nutritional status, reduced functional independence, female sex, polypharmacy, prolonged hospitalization, dementia, prior cardiac surgeries, and valvular heart disease. Clinical presentations ranged from sudden to gradual onset and included dysphagia, globus sensation, and hoarseness. Reported management strategies included nutritional support, swallowing rehabilitation, HF optimization, pharmacologic therapy, procedural interventions, and follow-up monitoring.

HFAD appears to be a common yet underrecognized comorbidity among individuals with HF and is associated with substantial adverse outcomes. Although early recognition and multidisciplinary management may be beneficial, evidence regarding optimal screening and treatment approaches remain limited. Further research is needed to establish standardized definitions, diagnostic criteria, screening approaches, and management pathways.