**3. Results**

### **3.1. Demographic characteristics and medical information**

The highest incidence of disease was found in males with a mean age of 59.11±10.14 years. The most common diseases found in the current study were hypertension, DM, and ischemic heart disease (IHD). The medications used the most were statins, aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors (ACE-Is). Other demographic characteristics and medical information are illustrated in Table 1.

### **3.2. Severity of dysphagia types and its symptoms**

The incidence (and percentage) of current patients complaining of dysphagia and its symp‐ toms during therapy were 122 (21.2%), 177 (30.7%), 265 (46%), and 286 (49.7%) for dysphagia, indigestion, cough, and chest pain, respectively. Mild symptoms were the highest incidences followed by moderate and severe (as shown in Figure 1).

Spearman's rank correlation showed a positive significant (2-tailed, *p*< 0.001) relationship between dysphagia and its symptoms. The correlation coefficient between dysphagia and its symptoms was 0.322, 0.146, and 0.126 for indigestion, cough, and chest pain, respectively. This result showed that the incidence of esophageal dysphagia was more frequent than that of oropharyngeal dysphagia.


**Table 1.** Demographic characteristics and medical information of patients

#### **3.3. Predictors of dysphagia**

Gender, IHD, and statins were the most significant factors that must be involved in the regression model to insure the predictors of dysphagia could be determined (as shown in Table 2).


*χ2* = chi-square test; *df* = degrees of freedom; *p* = calculated probability

**Table 2.** Categorical variables included in the regression model

The incidence (and percentage) of current patients complaining of dysphagia and its symptoms during therapy were 122 (21.2%), 177 (30.7%), 265 (46%), and 286 (49.7%) for dysphagia, indigestion, cough, and chest pain, respectively. Mild symptoms were the highest incidences followed by moderate and severe (as shown in Figure 1). Impact of Polypharmacy on Deglutition in Patients with Coronary and Cardiac Diseases http://dx.doi.org/10.5772/61085 45

diseases % (No.) Medications % (No.) Gender (male) 74.3 (428) Statins 87.8 (506) Age (≤65) 68.9 (397) Aspirin 67.4 (388) Race Malay 39.6 (228) Beta-blockers 70.8 (408)

Other 2.3 (13) Angiotensin receptor

Smoking 14.8 (85) Trimetazidine 29.2 (168) Alcohol consumption 9.4 (54) Isosorbide dinitrate 23.1 (133) Hypertension 65.8 (379) Thiazides 6.8 (39) DM 39.9 (230) Furosemide 18.9 (109) IHD 39.8 (229) Spironolactone 6.3 (36) Arrhythmia 3.3 (19) Gliclazide 22.2 (128) Renal disease 2.4 (14) Metformin 25 (144) Thyroid diseases 2.3 (13) Digoxin 4.3 (25) Myocardial infarction 2.3 (13) Warfarin 5.6 (32)

Chinese 28.5 (164) Calcium channel blockers 24.5 (141) Indian 29.7 (171) ACE-Is 54 (311)

blockers (ARBs) 10.6 (61)

Clopidogrel 17.7 (102) Ticlopidine 11.3 (65) Prazosin 2.3 (13)

Figure 1. Incidence and severity of dysphagia and its symptoms **Figure 1.** Incidence and severity of dysphagia and its symptoms

Demographic data and

Table 1. Demographic characteristics and medical information of patients

3.2. Severity of dysphagia types and its symptoms

As a result of logistic regression, gender and IHD were found to be the significant risk factors involved in the high incidence of dysphagia. Female cardiac patients had inciden‐ ces of dysphagia that were approximately 1.8 times higher than those of males. Patients with IHD had incidences of dysphagia that were 1.8 times higher than those without (as shown in Table 3). Spearman's rank correlation showed a positive significant (2-tailed, p< 0.001) relationship between dysphagia and its symptoms. The correlation coefficient between dysphagia and its symptoms was 0.322, 0.146, and 0.126 for indigestion, cough, and chest pain, respectively. This result showed that the incidence of esophageal dysphagia was more frequent than that of oropharyngeal dysphagia.


The reference category for the model is no dysphagia. The backward stepwise logistic regression test was used. The Hosmer and Lemeshow goodness-of-fit test with *χ*<sup>2</sup> (*N* = 576) = 3.365 and *p* =0.186

**Table 3.** Predictors of dysphagia in cardiac outpatients

3.3. Predictors of dysphagia

**3.3. Predictors of dysphagia**

Table 2).

44 Seminars in Dysphagia

*χ2*

Gender, IHD, and statins were the most significant factors that must be involved in the regression model to insure the predictors of dysphagia could be determined (as shown in

Clopidogrel 17.7 (102) Ticlopidine 11.3 (65) Prazosin 2.3 (13)

**Demographic data and diseases % (No.) Medications % (No.)** Gender (male) 74.3 (428) Statins 87.8 (506) Age (≤65) 68.9 (397) Aspirin 67.4 (388) Race Malay 39.6 (228) Beta-blockers 70.8 (408)

Smoking 14.8 (85) Trimetazidine 29.2 (168) Alcohol consumption 9.4 (54) Isosorbide dinitrate 23.1 (133) Hypertension 65.8 (379) Thiazides 6.8 (39) DM 39.9 (230) Furosemide 18.9 (109) IHD 39.8 (229) Spironolactone 6.3 (36) Arrhythmia 3.3 (19) Gliclazide 22.2 (128) Renal disease 2.4 (14) Metformin 25 (144) Thyroid diseases 2.3 (13) Digoxin 4.3 (25) Myocardial infarction 2.3 (13) Warfarin 5.6 (32)

Chinese 28.5 (164) Calcium channel blockers 24.5 (141) Indian 29.7 (171) ACE-Is 54 (311) Other 2.3 (13) Angiotensin receptor blockers (ARBs) 10.6 (61)

**Categorical variables** *χ<sup>2</sup> df p*

= chi-square test; *df* = degrees of freedom; *p* = calculated probability

**Table 1.** Demographic characteristics and medical information of patients

**Table 2.** Categorical variables included in the regression model

Gender 6.181 1 0.013 IHD 7.909 1 0.005 Statins 4.539 1 0.033

#### **3.4. Polypharmacy and its impact on dysphagia**

Patients with polypharmacy (i.e. those using 5 or more medications) have a higher incidence (45.84%) of dysphagia than other patients (as shown in Figure 2).

Binary logistic regression showed that medication use was a risk factor in the incidence of dysphagia in cardiac outpatients. The incidence of dysphagia was about 2.8 and 3.2 times higher for patients taking 1–4 drugs and those taking ≥ 5 drugs (polypharmacy), respectively, than those taking no medications. However, the incidence of dysphagia in patients with polypharmacy was found to be higher than those taking fewer than 5 medications (as shown in Table 4).

shown in Table 3).

predictors of dysphagia could be determined (as shown in Table 2).

χ<sup>2</sup> = chi-square test; df = degrees of freedom; p = calculated probability

Male (ref.)

No (ref.)

Hosmer and Lemeshow goodness-of-fit test with χ<sup>2</sup> (N = 576) = 3.365 and p =0.186

Table 3. Predictors of dysphagia in cardiac outpatients

other patients (as shown in Figure 2).

3.4. Polypharmacy and its impact on dysphagia

Table 2. Categorical variables included in the regression model

Gender, IHD, and statins were the most significant factors that must be involved in the regression model to insure the

Gender 6.181 1 0.013 IHD 7.909 1 0.005 Statins 4.539 1 0.033

As a result of logistic regression, gender and IHD were found to be the significant risk factors involved in the high incidence of dysphagia. Female cardiac patients had incidences of dysphagia that were approximately 1.8 times higher than those of males. Patients with IHD had incidences of dysphagia that were 1.8 times higher than those without (as

> Variable β SE OR 95% CI p Gender Female 0.575 0.233 1.777 (1.148, 2.750) 0.010

> IHD Yes 0.599 0.207 1.820 (1.212, 2.731) 0.004

The reference category for the model is no dysphagia. The backward stepwise logistic regression test used was the

Categorical variables χ<sup>2</sup> df p
