Abstract
Background and aims: Frailty is a clinical syndrome of increased vulnerability to stressors, associated with adverse outcomes after stroke, but its impact on outcomes after transient ischaemic attack (TIA) remain unclear.
Methods: Retrospective analysis of 1185 patients referred by the emergency department (ED) who attended TIA clinic with a Clinical Frailty Scale (CFS) within two weeks. Records were combined from two routinely collected databases, and prevalence of frailty was determined. Frailty was classified as CFS score >/=4. Data were collected on date of death, and hazard ratios (HR) were determined through cox proportional hazard regression, adjusted for prognostic factors.
Results: 7945 patients were referred through the ED between 01/01/2016 and 12/03/2022. 1185 patients were included. 53.5% (n=634) had frailty. Patients with frailty tended to be older (median age 81 vs 74, p<0.001) and female (53.9% vs 39.9% p<0.001). TIA was diagnosed in 28.3% (n=335), 61.2% (n=205) of whom were frail. Stroke was diagnosed in 23.1% (n=274). 46.7% of these had frailty (n=128). In TIA patients and the whole cohort (WC), frailty (TIA: HR 2.69 [95%CI 1.23-5.87, p=0.013], WC: 2.58 [95%CI 1.64-4.08, p<0.001] ; and increasing age [HR 1.07 95% CI 1.04-1.12], were predictive of mortality. In stroke patients, only increasing age was predictive of death, (HR 1.11 [95%CI 1.04-1.19, p=0.003]).
Conclusions: Frailty is common in TIA and is predictive of mortality. Studies are required to investigate the effects of frailty on other outcomes after TIA, including: quality of life; progression to stroke; and how frailty impacts rehabilitation.