119Impact of Frailty on Healthcare Outcomes after Ischaemic Stroke in Patients with Atrial Fibrillation

Abstract

Background: Frailty is associated with increased mortality and institutionalisation among stroke patients, however, little is known about the impact of frailty on other important healthcare outcomes post stroke. One of the most common stroke mechanisms for older adults with frailty is atrial fibrillation (AF). We examined the impact of frailty on hospital length of stay (LOS) and 30-day mortality post stroke with AF. Methods: Data was collected using an existing database of stroke patients presenting consecutively to a large university hospital from August 2014-July 2016. A retrospective chart review was performed to assess pre-admission frailty, using the Clinical Frailty Scale (CFS), cut-off of ≥5 for established frailty. Baseline function was measured with the Modified Rankin Scale (mRS) score. Results: In total, 113 patients were identified with ischaemic stroke and AF; median age 80 years (range 54.101 years) and 60% male. Frail patients were significantly older, p = 0.008. Median pre-admission CFS score was 3 (+/.3) and 26.5% scored ≥5, indicating most were mildly to severely frail. Median pre-admission mRS was 1 (+/.2) increasing to 3 (+/.2) at discharge. Frail patients had significantly worse scores at baseline &discharge, p < 0.001. Frail patients (CFS ≥5) had statistically significantly longer acute hospital LOS, median 22 days vs. 15 for non-frail patients, p = 0.04. In all, 10% of non-frail but no frail patients were suitable/agreeable to avail of early supported discharge, p = 0.02. There was no significant difference in 30-day mortality. Baseline CFS scores correlated most closely with age (r = 0.42, p < 0.001) and post-stroke mRS (r = 0.41, p < 0.001). Conclusions: Though numbers were small, likely under-powering the study, these data suggest an association between frailty and increased LOS in older patients with ischaemic stroke and AF indicating that poor baseline functional status has a significant impact on outcome. Frailty measures could be added to thrombolysis criteria to enhance decisionmaking.