Dysphagia in heart failure: Demographics, nutritional status, and patient-reported outcomes

Background

Dysphagia, or difficulty swallowing, is an often underrecognized comorbidity in individuals with heart failure (HF), which can potentially affect nutrition, symptom burden, and overall well-being. Patients with HF may experience dysphagia due to the anatomical proximity of the heart and esophagus. Cardiac remodeling, such as cardiomegaly and left ventricular dilation, can result in external compression of the esophagus, disrupting normal swallowing function. Despite these plausible mechanisms, there is limited large-scale data on evaluating the prevalence and clinical impact of dysphagia in HF populations.

Objectives

This study aimed to compare nutritional status, health perception, quality of life, and fatigue among HF patients with and without dysphagia.

Methods

A retrospective analysis was conducted on HF patients enrolled in the All of Us Research Program. Nutritional status was assessed using serum albumin levels, body weight, and body mass index (BMI). Health perception and fatigue were evaluated through responses to the Overall Health Survey.

Results

Within the analysis of the All of Us Research Program, 14,243 participants with HF were identified, of which 2,903 (20.4%) reported dysphagia after excluding those with a history of cerebrovascular accidents. The HF cohort was predominantly aged ≥65 years (53.2%), predominantly non-Hispanic or Latino (81.7%), and mainly White (51.3%), with a slight female predominance (55.1%). Among participants with available left ventricular ejection fraction (LVEF) data, 64.1% had preserved ejection fraction (>50%). Dysphagia was more frequently observed in older individuals and women, and it was associated with significantly lower body weight (mean 89.3 vs. 93.5 kg) and serum albumin levels (35.3 g/L vs. 36.2 g/L; p < 0.001), despite both groups having BMI (mean ∼32 kg/m², indicating Class I obesity). Individuals with dysphagia consistently reported poorer general, physical, and mental health, along with lower quality of life; and greater fatigue severity compared to those without dysphagia (all p < 0.001).

Conclusions

Dysphagia is a prevalent and clinically significant comorbidity in patients with HF, especially in those with preserved ejection fraction and advanced age. HF patients with dysphagia experience worse nutritional status and patient-reported outcomes compared to those without dysphagia. These findings underscore the need for routine screening for dysphagia and a comprehensive nutritional assessment to improve management and outcomes in HF populations.