The Impact of Pre-Stroke Frailty on Post-Stroke Outcomes: A Prospective Cohort Study
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Authors
Fernandez, Aleisha
Date
Type
thesis
Language
eng
Keyword
Stroke , Epidemiology , Frailty
Alternative Title
Abstract
Background: Stroke is a major contributor to the burden of disability and morbidity globally. With an aging demographic and improved survival, the prevalence of frailty is increasing. However, there is limited prospective studies in North America on how pre-stroke functional status affects post-stroke outcomes. We sought to determine if pre-stroke frailty measured using Frailty Index affects stroke outcomes.
Methods: Participants with an imaging confirmed stroke were identified from a prospective stroke registry based at Kingston Health Sciences Center (KHSC) in Kington, Ontario. Using the Canadian Longitudinal Study on Aging Frailty Index - 62 (CLSA-FI-62) and modified Rankin Scale (mRS), pre-stroke frailty and post-stroke functional status at 3 months were measured to quantify the association. Covariates and effect modifiers were also investigated to study the epidemiological relationship. Pre-stroke frailty and additional predictors were then used to construct a prediction model for post-stroke outcomes. Results: 441 patients were enrolled in the study that were approximately 73 years old (SD = 14.2) and were 49.4% males. The prevalence of pre-stroke frailty and poor post-stroke outcome (mRS:3-6) was 53.5%. The covariates adjusted (based on the literature) in the logistic regression analysis included the age, sex, chronic kidney disease, COPD, dementia, heart disease, peripheral arterial disease and stroke. Individuals with pre-stroke frailty were more likely to experience poor post-stroke outcomes with a crude OR of 10.04 (95% CI 6.17 - 16.33, p = <0.0001), and an adjusted OR of 7.67 (95% CI 4.33 - 13.60, p = <0.0001). A prediction model was also created using predictors gathered a-priori and found that pre-stroke frailty was still a significant predictor when considering a wider range of variables.
Conclusion: Overall, results found that there was a strong crude and adjusted association between pre-stroke frailty and post-stroke outcomes. Pre-stroke frailty as a strong predictor of post-stroke outcomes was further confirmed in the development of a predictor model for 3-months mRS score. Understanding the association between pre-stroke frailty can improve the triaging of resources and provide more tailored care for frail individuals.
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Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
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Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.