Heart Failure and Dysphagia: A Scoping Review

Background

Swallowing is a complex physiological process involving the coordinated movement of food from the mouth to the stomach. Dysphagia, or difficulty swallowing, can arise from abnormalities in the anatomy or physiology of the structures involved in this process. In heart failure (HF) patients, dysphagia may occur due to the anatomical proximity of the esophagus to the heart. Despite its potential impact, this symptom is not routinely assessed in patients with HF.

Aim

This scoping review aims to summarize and synthesize the association of dysphagia with heart failure.

Methods

This scoping review was conducted using a comprehensive search strategy across databases including PubMed, CINAHL, Embase, and Google Scholar. The review adhered to the Joanna Briggs Scoping Review Methodology and complied with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The inclusion criteria focused on studies involving heart failure patients aged 18 years or older, with no restrictions on publication date or study duration, acknowledging the chronic nature of heart failure. To capture the global prevalence of the condition, no geographical limitations were applied. However, due to constraints in translation resources, only articles published in English or those with available English translations were included.

Results

A total of 36 articles were reviewed, comprising case reports (n=20), literature reviews (n=2), longitudinal studies (n=3), prospective cohort studies (n=5), retrospective cohort studies (n=5), and a cross-sectional study (n=1). Major risk factors for dysphagia include advanced age and poor oral health, with a higher prevalence observed following cardiac surgery and in patients with comorbidities such as dementia, chronic obstructive pulmonary disease, cancer, and anemia. Pathophysiological contributors include esophageal dysmotility and stricture, esophageal dilation causing cardiac compression, and cardiomegaly causing esophageal compression. Clinically, dysphagia in HF is associated with dehydration, malnutrition, aspiration, and suffocation. Furthermore, it is linked to higher readmission rate, prolonged hospital stays, non-home discharges, and increased mortality. More importantly, volume overload is both a contributing factor and an adverse outcome of dysphagia in HF patients. Management strategies range from dietary modifications and pharmacological treatments to invasive and non-invasive therapeutic measures. Continuous surveillance is essential to ensure early detection and prevention of complications.

Conclusions

Dysphagia is a prevalent and significant concern in heart failure (HF) patients, compounded by various risk factors and associated with notable clinical challenges and adverse outcomes. This review highlights the critical need for increased awareness and systematic management strategies for dysphagia in the HF population. Future research should prioritize the development and implementation of effective screening and intervention protocols to alleviate the impact of dysphagia on HF progression and enhance patient outcomes.