## 5 Conclusions  
Acoustic voice and speech features show promise as biomarkers for ADHF, possibly because systemic fluid accumulation in the lungs and larynx affect phonation and respiration. In this study, potential vocal biomarkers for ADHF were identified and evaluated based on a set of spoken recordings from patients receiving inpatient ADHF treatment. Logistic regression models were trained to classify recordings as pre-treatment (at admission) or post-treatment (at discharge). For each recording, these models output a probability that the recording was produced at discharge rather than at admission, with a classification accuracy as high as 69%. Additionally, the probability of discharge increased from the pre-treatment voice sample to the post-treatment sample for up to 80% of participants. Voice and speech characteristics at discharge were associated with longer maximum phonation times, more stable phonation, increased creak percent, faster speech rate, and reduced pausing compared to acoustic characteristics at admission for the same individuals.  
Conceptualization, R.E.H. and D.D.M.; data curation, O.M.M.; formal analysis, O.M.M.; funding acquisition, O.M.M., G.W.D., R.E.H. and D.D.M.; investigation, O.M.M., G.W.D., R.E.H., M.D.M., J.S. and D.D.M.; methodology, O.M.M., R.E.H., G.W.D., M.D.M., J.V.G. and D.D.M.; project administration, G.W.D., R.E.H. and D.D.M.; resources, G.W.D., R.E.H., M.D.M., J.S. and D.D.M.; software, O.M. and D.D.M.; supervision, G.W.D., M.D.M., J.S. and D.D.M.; validation, O.M.M.; visualization, O.M.M.; writing\(-\)original draft preparation, O.M.M.; writing\(-\)review and editing, O.M.M., G.W.D., R.E.H., M.D.M., J.S., J.V.G. and D.D.M. All authors have read and agreed to the published version of the manuscript.  
This project was supported by the Center for Assessment Technology and Continuous Health (CATCH) at Massachusetts General Hospital; the NIH National Institute on Deafness and Other Communication Disorders Grant T32 DC000038 (awarded to [PERSON] for trainee [PERSON]); the NIH National Heart, Lung, and Blood Institute Grant F31 HL143824 (awarded to [PERSON]); and the Voice Health Institute. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.  
**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Massachusetts General Brigham (protocol number 2015P000986, annual approval obtained on 15 April 2022).  
**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.  
**Data Availability Statement:** Mass General Brigham and Mass General are not allowed to give access to data without the Principal Investigator (PI) for the human studies protocol first submitting a protocol amendment to request permission to share the data with a specific collaborator on a case-by-case basis. This policy is based on very strict rules dealing with the protection of patient data and information. Anyone wishing to request access to the data must contact the corresponding author.  
**Acknowledgments:** The authors thank [PERSON], [PERSON], [PERSON], [PERSON], [PERSON], [PERSON], [PERSON], [PERSON], and [PERSON] for their support, guidance, and assistance in data collection.  
**Conflicts of Interest:** [PERSON] and [PERSON] have a financial interest in InnoVoyce LLC, a company focused on developing and commercializing technologies for the prevention, diagnosis, and treatment of voice-related disorders. [PERSON]'s and [PERSON]'s interests were reviewed and are managed by Massachusetts General Hospital and Mass General Brigham in accordance with their conflict-of-interest policies. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.