Dysphagia Management is Associated with Reduced Mortality in Patients with Moderate to Severe Acute Ischemic Stroke.

Introduction: Dysphagia and pneumonia are common complications in patients with acute ischemic stroke (AIS), contributing to increased morbidity and mortality. This study evaluated the impact of pneumonia and dysphagia management strategies (including dysphagia screening, speech therapy, and nasogastric tube use) on patients with AIS outcomes.

Methods: This nationwide, multicenter study included 181,704 patients with AIS from the Austrian Stroke Unit Registry (2006-2024). The impact of pneumonia and the influence of dysphagia management on favorable functional outcome (modified Rankin Scale ≤ 1) and mortality of patients with AIS were calculated using multivariable Poisson regression models.

Results: Pneumonia occurred in 15.7% of severely and in 6.7% of moderately affected patients with AIS and was associated with increased mortality (RR 1.61, 95% CI 1.50-1.72, p < 0.05) and inversely with favorable functional outcome (RR 0.37, 95% CI 0.31-0.44, p < 0.05). Dysphagia management was significantly (p < 0.05) associated with reduced mortality, especially in moderately to severely affected patients with AIS, but had a limited impact on functional outcome. After implementation of dysphagia screening, a significant (p < 0.05) decrease in pneumonia prevalence was noted.

Conclusion: Among patients with severe acute ischemic stroke, early dysphagia management strategies are associated with reduced mortality, while stroke-associated pneumonia remains a persistent predictor of poor prognosis. These findings underscore the important role of standardized dysphagia management in improving stroke care and patient outcomes.