Impact of Frailty Risk on Outcomes in Patients with Ischemic Stroke: A National Inpatient Sample Analysis

Introduction: Ischemic stroke is a leading cause of mortality and disability in the U.S., particularly among the elderly. Frailty, defined as increased vulnerability from physiological decline and associated with ageing, varies among individuals and may impact healthcare utilization and patient outcomes. This study aims to investigate the impact of frailty risk on outcomes in patients with ischemic stroke.

Methods: We analyzed all patients diagnosed with ischemic stroke in the National Inpatient Sample from 2016-2021. The Hospital Frailty Risk Score was calculated for each patient and stratified into low ( < 5), intermediate (5-15), and high-risk (>15) groups. Outcomes assessed included in-hospital mortality, routine discharge, total hospital charges, and length-of-stay (LOS). Univariate analyses and multivariable logistic and linear regressions were performed to identify independent predictors of outcomes.

Results: The study included 1,753,224 patients (median age 68 years, 47.08% females). Frailty risk distribution was 20.65% low, 58.58% intermediate, and 20.76% high risk. Overall, 6.82% of patients died during hospitalization, 63.27% were routinely discharged, the mean LOS was 3.70 days, and the mean total charges were $58,124.6. High frailty risk patients were older, had higher mortality rates, lower routine discharge rates, longer LOS, and higher total charges. Multivariable logistic regression (using high-risk as reference) indicated that intermediate (OR=0.26, p< 0.01) and low frailty (OR=0.092, p< 0.01) were significantly associated with reduced mortality. Additionally, low and intermediate frailty groups had higher odds of routine discharge (OR=3.78 and OR=2.13, respectively; p< 0.01), and were associated with lower total charges (decreases of $46,750 and $33,070, respectively; p< 0.01) and shorter LOS (reductions of 3.15 and 2.31 days, respectively; p< 0.01).

Conclusion : Frailty risk significantly impacts outcomes in ischemic stroke patients. Higher frailty is associated with increased mortality, reduced likelihood of routine discharge, longer hospital stays, and higher healthcare costs. Assessing frailty can enhance clinical decision-making and optimize resource allocation, ultimately improving patient outcomes in ischemic stroke management.