Life expectancy after an ischemic stroke or transient ischemic attack in older adults - the role of frailty.

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.