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. 2025 Aug;14(4):1539-1552.
doi: 10.1007/s40120-025-00783-1. Epub 2025 Jun 9.

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

Julian Frederic Hotz  1   2 , Lisa Kaindl  1 , Lisa Schneider  2 , Stefan Krebs  1 , Anel Karisik  3 , Dominika Mikšová  4 , Maximilian Bichler  1 , Lavinia Ritscher  1 , Moritz Staudacher  2   5 , Heimo Lagler  2 , Heinz Burgmann  2 , Wilfried Lang  6 , Julia Ferrari  1 , Michael Knoflach  3   7 , Marek Sykora  8   9 ; Austria Stroke Unit Registry Collaborators
Affiliations

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

Julian Frederic Hotz et al. Neurol Ther. 2025 Aug.

Abstract

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.

Keywords: Acute ischemic stroke; Dysphagia management; Pneumonia; Stroke-associated infections.

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Conflict of interest statement

Declarations. Conflict of Interest: Julian Frederic Hotz, Lisa Kaindl, Lisa Schneider, Stefan Krebs, Anel Karisik, Dominika Mikšová, Maximilian Bichler, Lavinia Ritscher, Moritz Staudacher, Heimo Lagler, Heinz Burgmann, Wilfried Lang, Julia Ferrari, Michael Knoflach, Marek Sykora has nothing to disclose. Ethical Approval: All scientific analyses were conducted under the supervision and approval of the Ethics Committee of Sigmund Freud University, Vienna, Austria (No. 1117-2024) and have therefore been performed in accordance with the ethical standards laid down in the Declaration of Helsinki and its later amendments. As a result of the retrospective nature of the study and the use of anonymized data, obtaining patient informed consent was not necessary.

Figures

Fig. 1
Fig. 1
Prevalence of stroke-associated pneumonia by stroke severity in Austrian stroke units (2006–2024). NIHSS National Institutes of Health Stroke Scale
Fig. 2
Fig. 2
Interaction effects of NIHSS upon admission (aNIHSS) and dysphagia management variables (dysphagia screening [DS], speech therapy [ST], and nasogastric tube use [NGT]) on the association between pneumonia and mortality (mRS 6, yellow) or favorable functional outcome (mRS 0–1, blue). NIHSS National Institutes of Health Stroke Scale
See this image and copyright information in PMC

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