Prevalence and implications of frailty in acute stroke: systematic review & meta-analysis

Abstract

Background frailty is common in older adults and associated with poor outcomes following illness. Although stroke is predominantly a disease of older people, our knowledge of frailty in stroke is limited. We aimed to collate the literature on acute stroke and frailty to estimate the prevalence of pre-stroke frailty and its associations with outcomes. Methods paired researchers searched multidisciplinary electronic databases for papers describing frailty and acute stroke. We assessed risk of bias using Newcastle-Ottawa tools appropriate to study design. We created summary estimates of pre-stroke frailty using random effects models. We collated whether studies reported significant positive associations between frailty and clinical outcomes in adjusted models. Results we included 14 studies (n = 27,210 participants). Seven studies (n = 8,840) used a frailty index approach, four studies (n = 14,924) used Hospital Frailty Risk Scores. Pooled prevalence of pre-stroke frailty was 24.6% (95% confidence interval, CI: 16.2–33.1%; low quality evidence, downgraded due to heterogeneity, bias). Combining frailty and pre-frailty (nine studies, n = 23,827), prevalence of any frailty syndrome was 66.8% (95%CI: 49.9–83.7%). Seven studies were at risk of bias, from participant selection or method of frailty assessment. Pre-stroke frailty was associated with all adverse outcomes assessed, including longer-term mortality (positive association in 6 of 6 studies reporting this outcome; odds ratio: 3.75 [95%CI: 2.41–5.70]), length of admission (3 of 4 studies) and disability (4 of 6 studies). Conclusions despite substantial heterogeneity, whichever way it is measured, frailty is common in patients presenting with acute stroke and associated with poor outcomes. This has implications for the design of stroke services and pathways.

Risk factors for frailty in older adults

“…[47] There are several previously published meta-analysis reports which all discussed the risk factors of frailty, but they focused only on the risk factors for frailty in specific populations. For instance, the research of Burton et al [48] only focused on the risk factors of frailty in acute stroke, and they only include 14 papers. The paper of Gallo et al [49] only focused on the risk factors of frailty in plastic surgery, and the study of Liu et al [50] only focused on the preoperative and postoperative delirium.…”

Predictive value of clot imaging in acute ischemic stroke: A systematic review of artificial intelligence and conventional studies

“…AI methods are designed to harvest information from medical imaging, in the context of various diseases, with the purpose of rapid and accurate diagnosis and prognosis. Stroke is a condition requiring prompt intervention and carries high morbidity and mortality rates [1] [2] [3]. Various AI methods were developed based on information provided by computed tomography (CT) and magnetic resonance (MR) neuroimaging.…”

Physical and brain frailty in stroke: shared occurrence and outcomes. A cohort study

“…1,2 Frailty assessment is increasingly being incorporated into acute care pathways but has yet to be routinely adopted in stroke. 2 Evidence suggests there is prognostic value in assessing for frailty in stroke: delirium, mortality and post-stroke cognitive outcomes are all associated with frailty status. 3,4 Frailty can be characterised as a state of multisystem physiological vulnerability with diminished capacity to manage external stressors.…”