DOI: 10.1161/jaha.126.049122 ISSN: 2047-9980

Dysphagia: A Novel Risk Factor for Poor Outcomes Following Cardiovascular Procedures

Anagh Astavans, Arindam Bagga, Anna Zaeske, Garrett Goldin, Ian Everitt, Rachel C. Frank, Rani K. Hasan, Faisal Rahman, Matthew Czarny, James H. Clark, Monica Mukherjee
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Background

Dysphagia, an increasingly recognized clinical marker of frailty, is prevalent among older adults yet its impact on cardiovascular postprocedural outcomes remains undetermined. This study evaluated the association between dysphagia and adverse outcomes following major cardiac interventions.

Methods

Using the TriNetX database (2020–2024), we retrospectively identified adults with and without dysphagia who underwent coronary artery bypass graft, implantable cardioverter‐defibrillator placement, transcatheter aortic valve replacement, surgical aortic valve replacement, or mitral transcatheter edge‐to‐edge repair. Cohorts were propensity matched based on demographics and comorbidities; a sensitivity analysis incorporated additional frailty markers. The 90‐day and 1‐year risks of mortality, stroke, aspiration pneumonia, infectious pneumonia, hypoxemia, intubation, foreign body in respiratory tract, and esophagogastroduodenoscopy were measured. Kaplan–Meier analyses on survival probability were performed. Hazard ratios (HRs) for mortality, and risk ratios for all outcomes with 95% CIs were calculated.

Results

Propensity matched cohorts of patients with and without dysphagia (coronary artery bypass graft, n=5152; implantable cardioverter‐defibrillator, n=4112; transcatheter aortic valve replacement, n=4066; surgical aortic valve replacement, n=1982; mitral transcatheter edge‐to‐edge repair, n=710) were well balanced. Dysphagia was associated with significantly increased 90‐day mortality following coronary artery bypass graft (HR, 1.321), implantable cardioverter‐defibrillator implantation (HR, 1.398), transcatheter aortic valve replacement (HR, 1.736), and surgical aortic valve replacement (HR, 1.341) (all P <0.01) but not mitral transcatheter edge‐to‐edge repair. Dysphagia also increased the 1‐year risk of stroke, hypoxemia, infectious pneumonia, and intubation across all procedures.

Conclusions

Dysphagia is associated with increased short‐term morbidity and mortality following common cardiovascular procedures. Incorporating dysphagia screening into perioperative workflows may improve patient selection and resource allocation, supporting its inclusion in guideline‐directed risk assessment and perioperative optimization pathways.

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