ABSTRACT NUMBER: ESOC2026A2382 DYSPHAGIA AFTER STROKE AND 90-DAY MORTALITY

Abstract Background and aims Dysphagia after stroke has been associated with early mortality, however evidence from contemporary stroke care is limited. We evaluated the association between dysphagia and 90-day mortality after first-ever stroke and assessed pneumonia influence on this association. Methods Consecutive patients with first-ever acute stroke underwent standardized dysphagia screening at four hospitals across Sweden. Primary outcome was 90-day all-cause mortality. Centre-stratified Cox proportional hazard models estimated the dysphagia-mortality association adjusted for age, NIHSS, and sex, with an additional model including pneumonia during the index hospitalisation. Results Among 1094 stroke patients (median age 75 years [IQR 64–82]; 42.8% women), 424 (38.8%) had dysphagia. Dysphagia was associated with higher 90-day mortality (adjusted HR 5.59; 95% CI 3.05–10.25; p<0.001). When including pneumonia, dysphagia remained associated with mortality (HR 5.17; 95% CI 2.81–9.52; p<0.001), and pneumonia was independently associated with mortality (HR 2.68; 95% CI 1.47–4.91; p=0.001). Furthermore, the highest 90-day mortality risk was observed in patients presenting with both dysphagia and pneumonia, compared with those with normal swallowing and no pneumonia (HR 13.8; 95% CI 5.9–32.3; p<0.001). Elevated mortality risk was also evident among non-dysphagic patients with pneumonia (HR 8.2; 95% CI 1.81–37.1; p=0.006) and among dysphagic patients without pneumonia (HR 5.86; 95% CI 3.05–11.25; p<0.001). Conclusions Post-stroke dysphagia is strongly associated with death at 90-days in patients treated with contemporary stroke care. Pneumonia during in-hospital stay combined with dysphagia further worsened mortality risk. Conflict of interest Vesna Mirkoska: nothing to disclose. Patricia Hägglund: nothing to disclose. Per Wester reports fees as a Clinical Events Committee member from Abbott. Liza Bergström: nothing to disclose.