Impact of Frailty on Healthcare Outcomes after Cardioembolic Ischaemic Stroke Due to Atrial Fibrillation

Rónán O’Caoimh (), Laura Morrison, Marion Hanley, Caoimhe McManus, Kate Donlon and Patricia Galvin
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Rónán O’Caoimh: Department of Geriatric and Stroke Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork City, Ireland
Laura Morrison: Department of Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland
Marion Hanley: Department of Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland
Caoimhe McManus: Department of Geriatric and Stroke Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork City, Ireland
Kate Donlon: Department of Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland
Patricia Galvin: Department of Stroke Medicine, University Hospital Galway, Newcastle Rd, H91 YR71 Galway City, Ireland

IJERPH, 2024, vol. 21, issue 3, 1-11

Abstract: Stroke due to atrial fibrillation (AF) is more common in older adults. Frailty is associated with AF. As little is known about the impact of frailty on cardioembolic stroke, we examined its association with important healthcare outcomes including mortality and functional outcome in stroke with AF. Data were collected from patients presenting consecutively to a regional university hospital to assess pre-admission frailty using the Clinical Frailty Scale (CFS) and function with the Modified Rankin Scale (mRS). Stroke severity was assessed on the National Institute of Health Stroke Scale (NIHSS). In total, 113 patients presenting between August 2014 and July 2016 were identified with cardioembolic stroke, median age 80 years; 60% were male. Their median NIHSS score was 6. The median pre-admission CFS score was 3; 26.5% scored ≥5/9, indicating frailty. The median pre-admission mRS scores increased significantly from 1 to 3 at discharge ( p < 0.001). Frailty was associated with worse mRS scores at discharge, odds ratio 1.5, ( p = 0.03). While no patients with frailty were suitable to avail of early supported discharge, 10% of those without frailty were ( p = 0.02). There was no significant difference in 30-day mortality. Frailty is prevalent among patients with cardioembolic stroke due to AF and was associated with poorer functional outcomes. Although the numbers were small, these data suggest that brief frailty assessments are useful to risk-stratify patients with acute cardioembolic stroke. Frailty status on admission with stroke due to AF can help identify those more likely to have poorer outcomes, to benefit from intervention, to require prolonged rehabilitation, and to avail of ESD.

Keywords: stroke; atrial fibrillation; frailty; hospital; mortality; length of stay; disability; rehabilitation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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