Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2025
Life expectancy after an ischemic stroke or transient ischemic attack in older adults - the role of frailty.
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Prins Susanna R, Damoiseaux-Volman Birgit A, van Erkelens Judith A, Vermeer Sarah E, Van der Velde Nathalie, Van den Berg-Vos Renske M
Аннотация
INTRODUCTION: Ischemic stroke and transient ischemic attack (TIA) reduce life expectancy in older adults. The impact of frailty on life expectancy following these events is unclear.
METHODS: This nationwide retrospective cohort study used data from the Dutch health insurance claims database Vektis. We included patients aged ≥70 with ischemic stroke or TIA in 2018, selecting frail individuals using the U-PRIM frailty index. A non-frail control group was selected using frequency matching on age, sex, and socioeconomic status. Mortality data up to May 2024 provided 5.4-6.4 years of follow-up. Kaplan-Meier survival curves and Cox regression were used to estimate survival and calculate hazard ratios (HRs) for the association between frailty and mortality. As a secondary outcome, cardiovascular events were assessed.
RESULTS: Among 16,778 frail and 10,069 non-frail patients, frailty was associated with higher mortality and shorter life expectancy. Mortality in frail vs. non-frail patients was 66 % vs. 55 % after ischemic stroke and 54 % vs. 36 % after TIA. Life expectancy was 3.8 vs. 5.2 years after ischemic stroke and 5.9 vs. >6.4 years after TIA. Adjusted HRs for the association of frailty with mortality were 1.30 after ischemic stroke and 1.72 after TIA. Cardiovascular events were more common in frail patients: 40 % vs. 38 % after ischemic stroke and 18 % vs. 13 % after TIA.
CONCLUSION: Frailty is associated with increased long-term mortality and reduced life expectancy after stroke or TIA. These findings may support treatment decisions and advanced care planning.
METHODS: This nationwide retrospective cohort study used data from the Dutch health insurance claims database Vektis. We included patients aged ≥70 with ischemic stroke or TIA in 2018, selecting frail individuals using the U-PRIM frailty index. A non-frail control group was selected using frequency matching on age, sex, and socioeconomic status. Mortality data up to May 2024 provided 5.4-6.4 years of follow-up. Kaplan-Meier survival curves and Cox regression were used to estimate survival and calculate hazard ratios (HRs) for the association between frailty and mortality. As a secondary outcome, cardiovascular events were assessed.
RESULTS: Among 16,778 frail and 10,069 non-frail patients, frailty was associated with higher mortality and shorter life expectancy. Mortality in frail vs. non-frail patients was 66 % vs. 55 % after ischemic stroke and 54 % vs. 36 % after TIA. Life expectancy was 3.8 vs. 5.2 years after ischemic stroke and 5.9 vs. >6.4 years after TIA. Adjusted HRs for the association of frailty with mortality were 1.30 after ischemic stroke and 1.72 after TIA. Cardiovascular events were more common in frail patients: 40 % vs. 38 % after ischemic stroke and 18 % vs. 13 % after TIA.
CONCLUSION: Frailty is associated with increased long-term mortality and reduced life expectancy after stroke or TIA. These findings may support treatment decisions and advanced care planning.