Perception and reality: assessing the accuracy of self-assessed dysphonia and dysphagia risk in people with cardiovascular disease

Background/objectives: Cardiovascular disease (CVD) is a chronic condition influenced by aging and lifestyle, and its effects extend to systems involved in voice and swallowing. Age-related changes in these functions are common, and when worsened by CVD, they can lead to isolation, malnutrition, and complications such as aspiration pneumonia. This study investigated how individuals with CVD perceive their risk of dysphonia and dysphagia compared with clinician-administered screening-based assessments. Methods: Seventy-three participants (mean age 65.2 years; 86.3% male) completed structured screening tools and self-report questionnaires. Dysphonia was evaluated using the GIRBAS scale and Voice Handicap Index-30, while dysphagia was assessed with the Swallowing Disturbance Questionnaire and Eating Assessment Tool-10. Spearman correlation analyses examined associations between perceived and assessed scores, and Wilcoxon signed-rank tests compared their differences. Results: There was a moderate to strong correlation for dysphonia (rho = 0.68, p < 0.01), with participants tending to overestimate voice problems. For dysphagia, correlation was moderate (rho = 0.52, p < 0.01), and significant underestimation of swallowing difficulties was observed. Conclusions: Routine monitoring of voice and swallowing should be included in prevention and rehabilitation programs for individuals with CVD. Increasing public awareness may support earlier detection and reduce related complications. Plain Language Summary Heart disease can affect more than just the heart. It may also influence everyday functions like speaking and swallowing. These problems are called dysphonia (voice difficulties) and dysphagia (swallowing difficulties). However, people are not always aware of these issues. In this study, we asked 73 people with cardiovascular disease how they perceived their own voice and swallowing problems. We then compared their answers with results from standard screening questionnaires used by clinicians. We found that people tended to overestimate problems with their voice, meaning they thought their voice was worse than it appeared in screening tests. On the other hand, they often underestimated swallowing difficulties, even when screening suggested there could be a problem. This is important because swallowing problems can lead to serious complications, such as malnutrition or pneumonia, if they are not detected early. Our results suggest that relying only on what patients report may not be enough. Simple screening tools should be regularly used in cardiac rehabilitation to help detect these issues early. Increasing awareness can also help people recognize symptoms sooner and seek appropriate care.