Dysphagia Hinders Hospitalized Patients with Heart Failure from Being Discharged to Home

Dysphagia Hinders Hospitalized Patients with Heart Failure from Being Discharged to Home

JUNICHI YOKOTA,^1,2 YOSHIKO OGAWA,³ YOSHIMI TAKAHASHI,⁴ NOBUHIRO YAMAGUCHI,⁴ NORIKO ONOUE,⁴ TSUYOSHI SHINOZAKI⁴ and MASAHIRO KOHZUKI¹

¹Department of Internal Medicine and Rehabilitation Science Disability Science, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
²Department of Rehabilitation, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan
³Department of Sport and Medical Sciences, Teikyo University, Hachioji, Tokyo, Japan
⁴Department of Cardiology, National Hospital Organization Sendai Medical Center, Sendai, Miyagi, Japan

Dysphagia, defined as a dysfunction in any stage or process of eating, is common among heart failure (HF) patients. In some diseases state, dysphagia hinders patients from being discharged to home. However, it remains unclear whether dysphagia affects discharge disposition of HF patients. This study aimed to identify the impact of dysphagia on discharge disposition of HF patients. A total of 323 patients, hospitalized with acute exacerbation of HF, were eligible for the study (excluding patients who lived at nursing care facilities before admission). Following the withdrawal of 37 patients, a total of 286 patients were analyzed. Dysphagia was determined using the functional oral intake scale (FOIS), which evaluates a patient's ability to swallow. The FOIS is a 7-point scale, with a level of le; 5 indicating dysphagia. Of the 286 patients analyzed, 231 (80.8%) were discharged to home, and 55 were discharged to nursing care facilities or rehabilitation hospitals (non-home). FOIS level was significantly lower, and dysphagia incidence was significantly higher among patients discharged to non-home than among those discharged to home. Multivariate analysis showed that FOIS level was an independent predictor of discharge disposition. Additionally, after propensity score matching, which was performed to adjust for baseline characteristics, FOIS level remained significantly lower in patients discharged to non-home than in those discharged to home. In conclusion, dysphagia hinders patients hospitalized with HF from being discharged to home. We conclude that evaluating dysphagia and its severity on admission is useful for predicting discharge disposition in patients hospitalized with HF.

Keywords —— discharge disposition; dysphagia; functional oral intake scale; heart failure; swallowing function

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Tohoku J. Exp. Med., 2019, 249, 163-171

Correspondence: Masahiro Kohzuki, M.D., Ph.D., Department of Internal Medicine and Rehabilitation Science Disability Science, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan.

e-mail: kohzuki@med.tohoku.ac.jp