Abstract TP330: Trajectory of Swallowing Impairment, Feeding and Death over One Year: Results from the Pharyngeal Electrical Stimulation for Acute Stroke Dysphagia trial

Background: Post stroke dysphagia is common and an independent predictor of poor outcome. We assessed the trajectory of swallowing impairment, feeding and death using data from the ongoing pharyngeal electrical stimulation for acute stroke dysphagia trial (PhEAST). Methods: PhEAST is an international (UK, Austria) prospective randomised open-label blinded-endpoint trial recruiting 800 adults with recent (2-31 days) ischaemic or haemorrhagic anterior or posterior circulation stroke and feeding-tube dependent dysphagia (functional oral intake scale [FOIS], score 1-3 of 7). Participants are randomised (1:1) to 6 days of pharyngeal electrical stimulation (PES) or no PES on top of best care. Measures are swallowing impairment assessed as dysphagia severity rating scale (DSRS, range 0-12, death 13) and FOIS (1-7, death 0), feeding status assessed as eating assessment tool-10 (EAT-10, 0-50, death 51) and feeding status scale (FSS, 0-5, death 6), function (modified Rankin scale, mRS, 0-5, death 6) and quality of life (EQ-5D-5L, range 1 to -0.5, death 0) at baseline and days 14, 90, 180 and 365. Data are number (%), median [interquartile range] or mean (standard deviation); results are still blinded and not adjusted for PES treatment. Results: As of 14 August 2025, 430 participants had been recruited. In 250 participants with data at one year: age 75 (SD 13), female 102 (41%), onset to recruitment 15 [9-21] days, DSRS 12 [11, 12], NIHSS 13.3 (7.2), mRS 4 [4, 5]. By 1 year, 86 (40.3%) participants had died (Table). In alive participants, swallowing had returned to normal allowing oral feeding by one year in more than 50% of participants, DSRS 0 [0, 4], FOIS 7 [5, 7], EAT-10 2 [0, 10], FSS 0 [0, 1]. In contrast, participants who were alive at one year only had modest improvements in functional outcome, mRS 2 [0, 4], and quality of life, EQ-5D-5L 0.40 (0.32) (Table). Conclusions: In patients requiring tube-feeding due to post-stroke dysphagia, mortality exceeds 40% by 1 year. However, swallowing and feeding returns to normal in a majority of patients who survive. The effect of PES on these measures will be analysed after trial completion.