DOI: 10.1161/jaha.126.050186 ISSN: 2047-9980

Frailty and 1‐Year Prognosis of Patients With Ischemic Stroke: A Multicenter Cohort Study

Jiamin Xu, Xinyan Hu, Xinying Huang, Qianmei Jiang, Haochen Chi, Zhaoyang Zhao, Qinghong Xu, Detao Zeng, Zhikai Zhu, Xia Meng, Yilong Wang, Xiaoling Liao, Xingquan Zhao, Jinxi Lin, Zixiao Li, Yongjun Wang, Jing Jing
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Background

Frailty is a multidimensional geriatric syndrome characterized by reduced physiological reserve and is consistently associated with adverse outcomes in cardiovascular diseases. Frailty has also been linked to poor short‐term prognosis in cerebrovascular disease. However, its association with long‐term functional recovery and stroke recurrence remains insufficiently established in large prospective cohorts.

Methods

We conducted a cohort study using data from the Impairment of Cognition and Sleep Study of the China National Stroke Registry III. Frailty was assessed at baseline using a deficit accumulation frailty index and categorized as robust, pre‐frail, or frail. Primary outcomes were 1‐year excellent functional outcome (modified Rankin Scale 0–1), favorable functional outcome (modified Rankin Scale 0–2), and stroke recurrence. Secondary outcomes were corresponding outcomes at 3 and 6 months. Associations were evaluated using multivariable logistic and Cox regression models.

Results

Among 2396 patients, 65.3% were robust, 18.0% pre‐frail, and 16.7% frail. Increasing frailty severity was independently associated with lower odds of 1‐year excellent functional outcome (pre‐frail: odds ratio [OR], 0.6; 95% CI, 0.4–0.8; frail: OR, 0.2; 95% CI, 0.2–0.3; P for trend <0.001). Frail patients also had higher stroke recurrence risk (hazard ratio [HR], 1.90; 95% CI, 1.33–2.71) and lower likelihood of favorable functional outcome. Similar dose–response relationships were observed at 3 and 6 months, with consistent findings in sensitivity and subgroup analyses.

Conclusions

Frailty is common after acute ischemic stroke and shows a strong, graded association with 1‐year functional recovery, supporting its potential value for long‐term prognostic stratification beyond age and comorbidity burden.

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