Does frailty predict post stroke mortality?

McEnhill, Paul; Torsney, Kelli M.; Rajkumar, Chakravarthi

doi:10.1093/ageing/afaa030

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…We can hypothesise that RCI “age >80” could be a vague description of the subjective clinician’s impression of the subject’s frailty. It is known that frailty increases the probability of poor outcomes [ 27 , 28 , 29 ], and sometimes it is hard to predict if the frail patient will benefit from RT. Although RT in the elderly is another questionable concept among clinicians, age should not be a contraindication for RT per se [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Posterior Circulation Stroke Patients Receive Less Reperfusion Therapy Because of Late Arrival and Relative Contraindications: A Retrospective Study

Ekkert,

Milmantienė,

Jokimaitytė

et al. 2023

JCM

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Background. Reperfusion treatment (RT) is administered to individuals with posterior circulation strokes (PCS) later and less frequently. We aimed to study the impact of demographic and clinical factors on the decision for RT in PCS. Methods. We conducted a retrospective analysis of the data from 500 subjects admitted to the tertiary stroke centre’s emergency department between 2018 and 2020 due to PCS. Demographic and clinical factors were analysed among three groups: the RT group, the group with no RT because of absolute contraindications (ACI), and the group with no RT because of relative contraindications (RCI). Results. Of the patients, 202 (40.3%) were female. The median NIHSS was four (4), and the subjects’ median age was 69 (18). RT was performed on 120 (24%) subjects. FAST symptoms (OR—5.62, 95% CI [2.90–12.28]) and higher NIHSS (OR—1.13, 95% CI [1.09–1.18]) at presentation, atrial fibrillation (OR—1.56, 95% CI [1.02–2.38]), hypertension (OR—2.19, 95% CI [1.17–4.53]) and diabetes (OR—1.70, 95% CI [1.06–2.71]) increased the chance of RT. Late arrival was the most prevalent ACI for 291 (58.2%) patients. FAST-negative subjects (OR—2.92, 95% CI [1.84–4.77]) and males (OR—1.58, 95% CI [1.11–2.28]) had a higher risk of arriving late. Because of RCI, 50 (10%) subjects did not receive RT; the majority were above 80 and had NIHSS ≤ 5. Subjects with RCI who received the RT had a higher NIHSS (4 vs. 3, p < 0.001), higher hypertension (59 (92.2%) vs. 35 (77.8%), p = 0.032) and heart failure (23 (35.9%) vs. 7 (15.6%), p = 0.018) prevalence. There was a trend for less RT in females with RCI. Conclusions. Late arrival was the most common barrier to RT, and the male gender increased this risk. because of relative contraindications, 10% of subjects were not considered for RT. The presence of FAST symptoms, vascular risk factors, and a higher NIHSS increased the chance of RT.

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Section: Discussionmentioning

confidence: 99%

Posterior Circulation Stroke Patients Receive Less Reperfusion Therapy Because of Late Arrival and Relative Contraindications: A Retrospective Study

Ekkert,

Milmantienė,

Jokimaitytė

et al. 2023

JCM

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“…Recent papers have described pre-stroke frailty but few have assessed frailty in stroke survivors. 2,3 For a condition predominantly seen in International Journal of Stroke, 18 (6) older adults and associated with high burden of disability, this represents a fundamental research gap agreed by patients, carers, practitioners and researchers. 2,4 An understanding of frailty prevalence in stroke survivors is essential for planning equitable stroke services.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, measurement, and implications of frailty in stroke survivors: An analysis of three global aging cohorts

Hanlon

Burton

Quinn

et al. 2023

International Journal of Stroke

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Background: Our understanding of the relationship between frailty and stroke, beyond the acute phase of stroke, is limited. We aimed to estimate the prevalence of frailty in stroke survivors using differing methods of assessment and describe relationships with stroke outcomes. Methods: We used data from three international population surveys (American Health and Retirement Survey/English Longitudinal Study of Ageing/Survey for Health and Retirement in Europe) of ageing. Frailty status was assessed using the Fried frailty phenotype, a 40-item frailty index (FI) and the clinical frailty scale (CFS). We created estimates of frailty prevalence and assessed association of frailty with outcomes of mortality/hospital admission/recurrent stroke at 2 years follow-up using logistic regression models adjusted for age/sex. Additional analyses explored effects of adding cognitive measures to frailty assessments and of missing grip strength data. Findings: Across 9617 stroke survivors, using the frailty phenotype, 23.8% (n=2094) identified as frail; with CFS 30.1% (n=2906) were moderately or severely frail; using FI, 22.7% (n=2147) had moderate frailty and 31.9% (n=3021) severe frailty. Frailty was associated with increased risk of mortality/hospitalization/recurrent stroke using all three measures. Adding cognitive variables to the frailty index produced minimal difference in prevalence of frailty. People with physical frailty (phenotype or CFS) plus cognitive impairment had a greater risk of mortality than people with an equivalent level of frailty but no cognitive impairment. Excluding people unable to provide grip strength underestimated frailty prevalence. Interpretation: Frailty is common in stroke and associated with poor outcomes, regardless of measure used. Adding cognitive variables to frailty phenotype/CFS measures identified those at greater risk of poor outcomes. Physical and cognitive impairments in stroke survivors do not preclude frailty assessment.

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“…They suggested that future research should focus on which patients with stroke would benefit from specialty PC. 13 Current evidence suggests that a patient's prestroke frailty status impacts outcomes after acute stroke [14][15][16][17] and may be an appropriate trigger for PCC. However, the best way to screen for frailty after acute stroke has not been well explored.…”

mentioning

confidence: 99%

“…Current evidence suggests that a patient’s prestroke frailty status impacts outcomes after acute stroke 14-17 and may be an appropriate trigger for PCC. However, the best way to screen for frailty after acute stroke has not been well explored.…”

mentioning

confidence: 99%

Evaluating the FRAIL Questionnaire as a Trigger for Palliative Care Consultation After Acute Stroke

Keiser

Buterakos

Stutzky

et al. 2023

J Hosp Palliat Nurs

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The American Heart Association and the American Stroke Association jointly released guidelines stating that all patients with a new diagnosis of stroke should receive palliative care consultation starting in the acute phase of care. The purpose of this project was to increase palliative care consultation rates for patients after an acute stroke by using a frailty score to trigger a palliative care consult. Provider education on palliative care and a 5-question fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) questionnaire was delivered by a presentation, handouts, and a follow-up email using previously developed content. Patients included adults admitted to the neuroscience critical care unit of a Midwestern comprehensive stroke center with an admission diagnosis of acute stroke (n = 120). The charge nurse completed the FRAIL questionnaire as a screening tool to trigger a palliative care consult. A survey was also distributed to providers (n = 54) to understand their knowledge, thoughts, and feelings toward palliative care. There was an increase in patients who received palliative care consultation from 14.9% to 21.7% after implementation of the FRAIL questionnaire. Also, providers felt better able to provide symptom management to patients after acute stroke. Further research is necessary to determine if the FRAIL survey is an adequate trigger for palliative care consultation.

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Does frailty predict post stroke mortality?

Cited by 5 publications

References 11 publications

Posterior Circulation Stroke Patients Receive Less Reperfusion Therapy Because of Late Arrival and Relative Contraindications: A Retrospective Study

Posterior Circulation Stroke Patients Receive Less Reperfusion Therapy Because of Late Arrival and Relative Contraindications: A Retrospective Study

Prevalence, measurement, and implications of frailty in stroke survivors: An analysis of three global aging cohorts

Evaluating the FRAIL Questionnaire as a Trigger for Palliative Care Consultation After Acute Stroke

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