Prevalence and associations of post-stroke frailty: a cross-sectional study

Abstract

INTRODUCTION: There is little data on stroke and frailty, especially from South Asia. We aimed to study the prevalence and associations of post-stroke frailty in a cohort of stroke survivors. METHODS: We studied all patients attending a tertiary care stroke clinic over 1 year (September 2023-August 2024). Patients with an index stroke event occurring 1 to 5 years earlier were included. Data on demographic features, stroke characteristics, functional outcome, and frailty were studied. Frailty was assessed with the Clinical Frailty Scale (CFS), stroke severity with the National Institute of Neurological Disorders and Stroke scale (NIHSS), and functional status with the modified Rankin Scale (mRS). Frailty was defined by a CFS score of ≥5 and functional dependence by an mRS score of 3-5. Strokes were categorized as mild (NIHSS score of 1-4), moderate (5-14), or severe (>14). Associations of post-stroke frailty were studied using logistic regression. RESULTS: A total of 143 patients with stroke (mean age 58 ± 10 years, male 91 [63.6%]) with a mean follow-up of 2.7 (±1.6) years were studied. Of them, 141 (98%) were functionally independent before stroke onset. The majority (115 [80.4%]) had ischemic strokes, and 106 (74%) patients had moderate to severe strokes (admission NIHSS ≥5). On follow-up, 47 patients (33%) were frail (CFS ≥5), with 13 patients (9.1%) having moderate to severe frailty (CFS 6-9). Functional dependence on follow-up was seen in 33 patients (23%). Post-stroke frailty was independently associated with increasing age (p = 0.012), diabetes (p = 0.039), and admission stroke severity (p = 0.001) in a multivariable analysis. Biological sex, stroke type, other vascular risk factors, and duration of follow-up were not associated with post-stroke frailty. CONCLUSIONS: This is the first report on post-stroke frailty in South Asia. One-third of stroke survivors were frail on follow-up. Older age, diabetes and stroke severity were independent predictors of post-stroke frailty.