Abstract T MP68: The Concept of Frailty in Association with Patient Outcomes among Ischemic Strokes

Abstract

Introduction: The concept of frailty as a state of decreased reserve and cumulative decline in multiple physiologic systems resulting in poor outcomes is well accepted in geriatrics. However, the impact of frailty on outcomes after ischemic stroke is less well understood. Our objectives were to identify a frailty score based on age-related deficits and to determine its association with stroke outcomes. Methods: Ischemic strokes within a biracial population in the Greater Cincinnati area in 2005 were identified. Research nurses extracted information from the medical charts including 35 age-related deficits that included comorbidities and admission lab values. A frailty score was identified using exploratory factor analysis to eliminate deficits with poor fit, followed by a two-parameter logistic latent trait model. Logistic regression was then used to evaluate association between frailty score (tertiles) and in-hospital mortality (death or discharged to hospice), dependent at discharge (mRS ≥ 2), discharge home and 1 year mortality. Models adjusted for age, race, sex, NIHSS, and pre-stroke mRS. Results: A total of 2,092 first event ischemic cases were identified in 2005. The median age was 72 years, 23% black, 56% female, median NIHSS 4 (IQR 2, 8). Of the 35 deficits, 15 loaded on the frailty factor: assisted living, aid to walk, dementia, depression, congestive heart failure, cardiac pacemaker, carotid artery disease, coronary artery disease, atrial fibrillation, impairment from prior stroke, hypertension, diabetes, elevated cholesterol, peripheral vascular disease, and abnormal hemoglobin. Higher frailty score was associated with increased in-hospital mortality, poor discharge mRS, and 1 year mortality (Table 1). Discussion: We created a frailty score based on 15 age-related deficits and showed strong association with poor outcomes. This frailty score could be useful for clinical care, as well as research, to identify age-related physiologic decline.