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A change in voice

BMJ 2025; 388 doi: https://doi.org/10.1136/bmj-2024-079623 (Published 21 January 2025) Cite this as: BMJ 2025;388:e079623

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Heart failure is a cause of change in voice

Dear Editor

Heart failure should be included in the list of causes of change in voice. Vocal cord oedema is one mechanism (1), though autonomic nervous system changes may also contribute (2).

Artificial neural networks analysing voice patterns have shown promise in detecting heart failure in small studies (3,4,5). We aim to confirm these results in larger, real-world populations (6). Systematically and fully harnessing the information provided by the patient's voice may provide clinicians with another tool to monitor and diagnose this often-missed (7) condition.

1. McDonagh, T. A., Metra, M., Adamo, et al. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 42(36), 3599–3726. https://doi.org/10.1093/eurheartj/ehab368
2. Maor, E., Perry, D., Mevorach, et al. (2020). Vocal Biomarker Is Associated With Hospitalization and Mortality Among Heart Failure Patients. Journal of the American Heart Association, 9(7), e013359. https://doi.org/10.1161/JAHA.119.013359
3. Firmino, J. V., Melo, M., Salemi, V., et al. (2023). Heart failure recognition using human voice analysis and artificial intelligence. Evolutionary Intelligence, 16(6), 2015–2027. https://doi.org/10.1007/s12065-023-00843-1
4. Kiran Reddy, M., Helkkula, P., Madhu Keerthana, et al. (2021). The automatic detection of heart failure using speech signals. Computer Speech & Language, 69, 101205. https://doi.org/https://doi.org/10.1016/j.csl.2021.101205
5. Schöbi, D., Zhang, Y., Kehl, J., et al. (2022). Evaluation of Speech and Pause Alterations in Patients With Acute and Chronic Heart Failure. Journal of the American Heart Association, 11(21), e027023. https://doi.org/10.1161/JAHA.122.027023
6. Charman, S. J., Okwose, N. C., Groenewegen, A., et al. (2025). Clinical validation of an artificial intelligence-based decision support system for diagnosis and risk stratification of heart failure (STRATIFYHF): a protocol for a prospective, multicentre longitudinal study. BMJ Open, 15(1), e091793. doi:10.1136/bmjopen-2024-091793
7. Bottle, A., Kim, D., Aylin, P., Cowie, M. R., Majeed, A., & Hayhoe, B. (2018). Routes to diagnosis of heart failure: observational study using linked data in England. Heart, 104(7), 600. https://doi.org/10.1136/heartjnl-2017-312183

Competing interests: The authors are members of the STRATIFYHF consortium

31 January 2025
Duncan AH Edwards
General Practitioner
Amy Fuller, Nduka Okwose, Fatima Bano, Sarah Charman, Djordje Jakovljevic
University of Cambridge
Worts Causeway
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