Xerostomia in patients with heart failure - prevalence, intensity and reported strategies of symptom reduction

Abstract

Abstract Background Xerostomia is a common symptom in patients with chronic heart failure (CHF), with a reported prevalence rate of up to 62%. It is defined as the perception of oral dryness, along with swallowing difficulties, oral burning, and altered taste. Despite being a widespread symptom, xerostomia is insufficiently studied CHF patients from german-speaking countries. Purpose The purpose of this study was to assess the prevalence, perceived intensity, and severity of xerostomia in German CHF patients. Additionally, patients´ reported strategies of symptom reduction were investigated. Methods Multi-center, cross-sectional study. Patients with a confirmed diagnosis of heart failure were recruited during visits to heart failure outpatient clinics or while hospitalized for any reason. If they consented to participate, they received a self-administered questionnaire containing questions about xerostomia, perceived distress and severity of xerostomia, and patients' measures to reduce xerostomia. Disease-related data were extracted from the patients' medical records. Perceived intensity of mouth dryness was measured using a visual analog scale (VAS) with 0 for "little dry" and 100 for "maximum imaginable dryness." To assess the severity of xerostomia, the short version of the xerostomia inventory (XI) was used with 5 items inquiring about the frequency of specific xerostomia symptoms. Sumscores of the XI ranged from 5 to 15, with higher scores indicating a higher severity of xerostomia. Measures to reduce dry mouth could be stated in patients' own words. Results Overall, 371 patients with a mean age of 62.4 (± 14.9) took part in this study. Most patients (230; 62%) had CHF with reduced ejection fraction. The main aetiology for heart failure was ischemic heart disease (118; 31.8%), followed by dilated cardiomyopathy (116; 31.3%). Out of 371 patients, 361 answered the question of whether they had suffered from dry mouth in the last three days. The prevalence rate of xerostomia was 65% (n=234) (95% CI: 60%; 70%). Perceived intensity of mouth dryness, using VAS, was 55.5 (± 22.3). The median severity score of the XI was 9 (Interquartile-Range: 8;11). Patients mostly experienced dry mouth in the morning and at night. The most frequently mentioned measures against dry mouth were drinking something (water, juice, coffee, tea, buttermilk), rinsing or moistening the mouth, sucking candies (sugar-free candies, peppermint, lemon, menthol), eating fruits, and using chewing gums. Conclusion Xerostomia is a widespread symptom in German heart failure patients, affecting more than half of the patients included in the study. The intensity and degree of severity appear to be in a medium range. CHF patients used various interventions to relieve the burden of xerostomia. These measures should be further investigated for their effectiveness.