FRAILTY is a critical predictor of mortality and neurological outcome in older patients undergoing endovascular therapy for ischemic stroke, according to a national German registry analysis involving over 2,400 patients.
The study, which examined outcomes in patients aged 65 and older across seven academic stroke centers, utilized the Hospital Frailty Risk Score (HFRS) to categorize patients into low-, intermediate-, and high-risk frailty groups. Researchers found that higher frailty scores were strongly linked to both lower rates of favorable neurological recovery and increased mortality three months post-stroke.
Among the 2,468 patients analyzed, 18.2% had high frailty risk (HFRS > 5). Functional independence, defined by a modified Rankin Scale (mRS) score of 0–2, was achieved in only 13.8% of high-risk patients, compared with 31.7% in the low-risk group. Even after adjusting for confounding factors, each point increase in HFRS was significantly associated with reduced odds of functional recovery (adjusted OR: 0.962) and increased mortality (adjusted OR: 1.033).
Importantly, baseline stroke severity, as measured by NIH Stroke Scale scores, did not significantly differ between frailty groups, indicating that frailty independently contributes to poor outcomes. Delays in treatment were also observed among the frailest patients, with a median door-to-groin time of 80 minutes compared to 64 minutes in the least frail, suggesting potential systemic or clinical hesitation in this subgroup.
These findings underscore the need for integrating frailty assessments into acute stroke care pathways. Early identification of frailty may inform clinical decision-making, resource allocation, and tailored post-stroke care plans in elderly patients undergoing thrombectomy.
Reference:
Schnieder M et al. Frailty’s influence on older stroke patients: Neurological outcome and mortality after endovascular treatment in stroke: A national German stroke registry analysis. Eur Stroke J. 2025:23969873251344202.
