Impact of Pre-Stroke Frailty on Outcome Three Years after Acute Stroke: The Nor-COAST Study.

\n<bold><italic>Introduction:</italic></bold> We aimed to explore the predictive value of pre-stroke frailty index (FI) on functional dependency and mortality 3 years after stroke. <bold><italic>Methods:</italic></bold> Based on the Rockwood 36-item FI score, we calculated the pre-stroke FI from medical conditions recorded at baseline in the multicenter prospective Nor-COAST study 2015–2017. Participants with a FI score and a modified Rankin scale (mRS) 0–6 3 years post-stroke were included in this study. We used logistic regression analysis with unfavorable mRS (over 2 vs. 0–2) at 3 years, or dead within 3 years, as dependent variable, and frailty and pre-stroke mRS, one at a time, and simultaneously, as predictors. The analyses were carried out unadjusted and adjusted for the following variables one at a time: Age, sex, years of education, stroke severity at admission, infections treated with antibiotics and stroke progression. We report odds ratio (OR) per 0.10 increase in FI. <bold><italic>Results:</italic></bold> At baseline, the 609 included patients had mean age 72.8 (standard deviation [SD] 11.8), 261 (43%) were females, and had a FI mean score of 0.16 (SD 0.12), range 0–0.69. During 3 years, 138 (23%) had died. Both the FI, and pre-stroke mRS, were strong predictors for unfavorable mRS (OR 4.1 and 2.7) and dead within 3 years (OR 2.2 and 1.7). Only adjusting for age affected the result. The OR for pre-stroke mRS decreased relatively more than the OR for FI when entered as predictors simultaneously. <bold><italic>Conclusions:</italic></bold> FI is a stronger predictor than premorbid mRS for prognostication after stroke. Stroke is a leading cause of dead and disability in the world. It is an acute condition prevalent in older populations. As more older adults surviving previously fatal strokes, the prevalence of stroke survivors with different functional and cognitive impairments increase. There is a great heterogeneity in outcome after stroke, even in milder strokes. We know less of what predict poor outcome. While increasing age in general is associated with poor outcome, at individual plan the relationship with age is more uncertain. Frailty is a concept gaining more attention over the recent years. It is defined as a condition of vulnerability associated with an increased risk of adverse health outcomes such as functional decline and mortality. Frail people have an increased risk of developing disease when something extraordinary occurs. Less is known about the relationship between stroke and frailty. Frailty assessment is not yet part of routine stroke care. In this study, we explored the impact of pre-stroke frailty on functional dependency and mortality 3 years after stroke. We found that the degree of frailty before stroke had a huge impact on functional status and mortality 3 years after stroke, even when we adjusted for important factors, like stroke severity and age. This demonstrates the importance of implementing frailty measures as a routine tool in stroke medicine. It also underline the value of developing preventing mechanisms of frailty in the older population. [ABSTRACT FROM AUTHOR]