Background: Post-stroke dysphagia is common, associated with poor outcome, and patients often require non-oral feeding/fluids. The relationship of feeding status on outcome, and treatment with transdermal glyceryl trinitrate (GTN) was studied in the ENOS trial.
Methods: ENOS assessed GTN (5 mg vs none for 7 days) in 4,011 patients with acute stroke and high blood pressure. Feeding status (oral = normal diet, soft diet; non-oral = nasogastric tube, percutaneous endoscopic gastrostomy tube, parenteral fluids, none) was assessed at baseline and day 7. The primary outcome was the modified Rankin Scale (mRS) measured at day 90. Analyses of outcomes were adjusted for baseline covariates. †2p<0.001.
Results: In comparison with oral feeding, non-oral patients (N=1331, 33.2%) were older (73.9 vs 68.5 years†), more likely to be female (47.3 v 40.4%†) and had more severe stroke (Scandinavian Stroke Scale 24.6 v 38.3†). By day 7, 56.8% patients had improved from non-oral to oral feeding, and 4.4% had deteriorated. Non-oral feeding at baseline was associated with more impairment at day 7 (SSS 29.0 v 43.7†), and higher mRS 4.0 (1.7) v 2.7 (1.6)†) and death (23.6% v 6.8%†) at day 90. Although GTN did not modify feeding status overall, randomisation to GTN <6 hours of stroke was associated with a significant shift to improved feeding status at day 7 (OR=0.61, 95% CI 0.38-0.98).
Conclusions: Non-oral feeding status is common in acute stroke and associated with more impairment, dependency and death. Very early administration of GTN improved feeding status, a finding that requires further testing.