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Background frailty is common in older adults and associated with poor outcomes following illness. Although stroke is predominantly a disease of older people, our knowledge of frailty in stroke is limited. We aimed to collate the literature on acute stroke and frailty to estimate the prevalence of pre-stroke frailty and its associations with outcomes. Methods paired researchers searched multidisciplinary electronic databases for papers describing frailty and acute stroke. We assessed risk of bias using Newcastle-Ottawa tools appropriate to study design. We created summary estimates of pre-stroke frailty using random effects models. We collated whether studies reported significant positive associations between frailty and clinical outcomes in adjusted models. Results we included 14 studies (n = 27,210 participants). Seven studies (n = 8,840) used a frailty index approach, four studies (n = 14,924) used Hospital Frailty Risk Scores. Pooled prevalence of pre-stroke frailty was 24.6% (95% confidence interval, CI: 16.2–33.1%; low quality evidence, downgraded due to heterogeneity, bias). Combining frailty and pre-frailty (nine studies, n = 23,827), prevalence of any frailty syndrome was 66.8% (95%CI: 49.9–83.7%). Seven studies were at risk of bias, from participant selection or method of frailty assessment. Pre-stroke frailty was associated with all adverse outcomes assessed, including longer-term mortality (positive association in 6 of 6 studies reporting this outcome; odds ratio: 3.75 [95%CI: 2.41–5.70]), length of admission (3 of 4 studies) and disability (4 of 6 studies). Conclusions despite substantial heterogeneity, whichever way it is measured, frailty is common in patients presenting with acute stroke and associated with poor outcomes. This has implications for the design of stroke services and pathways.

Frailty, the clinical syndrome, can be defined by using either the phenotypical or the deficit model. Linda Fried proposed the former in 2001. John Rockwood in 1999 proposed the deficit model. There are several instruments that can be used to define frailty. We sought to determine the prevalence of frailty in acute stroke patients.We searched MEDLINE, EMBASE and CINAHL up to November 2018, using a pre-defined search criteria, in accordance with PRISMA guidance. Studies that used a defined measure of frailty were included. Studies that included transient ischaemic attack patients were excluded.A total of 1981 studies were screened, 9 studies met the inclusion criteria. Six studies were conference abstracts found in the grey literature. 1331 patients were included in total, of which 452 ( 34%) were said to be frail. Five different methods, for assessing frailty were used; the Clinical Frailty Scale, Rockwood Frailty index, Fried Frailty Criteria, Canadian Study on Health and Ageing Scale and the Reported Edmonton Frailty Scale were used.The review was limited by the small number of studies, this may be because frailty is a relatively new concept. Studies which included pre-morbid function were not included, if there was no measure of frailty. Our study suggests the need for further larger well designed studies that measure the prevalence of frailty in stroke patients and how frailty affects patient outcomes. Further work is also needed into what assessment method for frailty should be used