Life expectancy after an ischemic stroke or transient ischemic attack in older adults - the role of frailty

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-09-09 DOI:10.1016/j.jstrokecerebrovasdis.2025.108448

Susanna R. Prins MD , Birgit A. Damoiseaux-Volman PharmD, PhD , Judith A. van Erkelens , Sarah E. Vermeer MD, PhD , Nathalie Van der Velde MD, PhD , Renske M. Van den Berg-Vos MD, PhD

{"title":"Life expectancy after an ischemic stroke or transient ischemic attack in older adults - the role of frailty","authors":"Susanna R. Prins MD , Birgit A. Damoiseaux-Volman PharmD, PhD , Judith A. van Erkelens , Sarah E. Vermeer MD, PhD , Nathalie Van der Velde MD, PhD , Renske M. Van den Berg-Vos MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2025.108448","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Ischemic stroke and transient ischemic attack (TIA) reduce life expectancy in older adults. The impact of frailty on life expectancy following these events is unclear.</div></div><div><h3>Methods</h3><div>This nationwide retrospective cohort study used data from the Dutch health insurance claims database Vektis. We included patients aged ≥70 with ischemic stroke or TIA in 2018, selecting frail individuals using the U-PRIM frailty index. A non-frail control group was selected using frequency matching on age, sex, and socioeconomic status. Mortality data up to May 2024 provided 5.4–6.4 years of follow-up. Kaplan-Meier survival curves and Cox regression were used to estimate survival and calculate hazard ratios (HRs) for the association between frailty and mortality. As a secondary outcome, cardiovascular events were assessed.</div></div><div><h3>Results</h3><div>Among 16,778 frail and 10,069 non-frail patients, frailty was associated with higher mortality and shorter life expectancy. Mortality in frail vs. non-frail patients was 66 % vs. 55 % after ischemic stroke and 54 % vs. 36 % after TIA. Life expectancy was 3.8 vs. 5.2 years after ischemic stroke and 5.9 vs. >6.4 years after TIA. Adjusted HRs for the association of frailty with mortality were 1.30 after ischemic stroke and 1.72 after TIA. Cardiovascular events were more common in frail patients: 40 % vs. 38 % after ischemic stroke and 18 % vs. 13 % after TIA.</div></div><div><h3>Conclusion</h3><div>Frailty is associated with increased long-term mortality and reduced life expectancy after stroke or TIA. These findings may support treatment decisions and advanced care planning.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 11","pages":"Article 108448"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Stroke & Cerebrovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1052305725002253","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Ischemic stroke and transient ischemic attack (TIA) reduce life expectancy in older adults. The impact of frailty on life expectancy following these events is unclear.

Methods

This nationwide retrospective cohort study used data from the Dutch health insurance claims database Vektis. We included patients aged ≥70 with ischemic stroke or TIA in 2018, selecting frail individuals using the U-PRIM frailty index. A non-frail control group was selected using frequency matching on age, sex, and socioeconomic status. Mortality data up to May 2024 provided 5.4–6.4 years of follow-up. Kaplan-Meier survival curves and Cox regression were used to estimate survival and calculate hazard ratios (HRs) for the association between frailty and mortality. As a secondary outcome, cardiovascular events were assessed.

Results

Among 16,778 frail and 10,069 non-frail patients, frailty was associated with higher mortality and shorter life expectancy. Mortality in frail vs. non-frail patients was 66 % vs. 55 % after ischemic stroke and 54 % vs. 36 % after TIA. Life expectancy was 3.8 vs. 5.2 years after ischemic stroke and 5.9 vs. >6.4 years after TIA. Adjusted HRs for the association of frailty with mortality were 1.30 after ischemic stroke and 1.72 after TIA. Cardiovascular events were more common in frail patients: 40 % vs. 38 % after ischemic stroke and 18 % vs. 13 % after TIA.

Conclusion

Frailty is associated with increased long-term mortality and reduced life expectancy after stroke or TIA. These findings may support treatment decisions and advanced care planning.

查看原文本刊更多论文

老年人缺血性中风或短暂性脑缺血发作后的预期寿命——虚弱的作用。

简介：缺血性中风和短暂性脑缺血发作（TIA）降低老年人的预期寿命。在这些事件之后，虚弱对预期寿命的影响尚不清楚。方法：这项全国性的回顾性队列研究使用了荷兰健康保险索赔数据库Vektis的数据。我们纳入了2018年年龄≥70岁的缺血性卒中或TIA患者，使用U-PRIM衰弱指数选择虚弱个体。采用年龄、性别和社会经济地位的频率匹配选择非体弱对照组。截至2024年5月的死亡率数据提供了5.4-6.4年的随访。Kaplan-Meier生存曲线和Cox回归用于估计生存率，并计算虚弱和死亡率之间关联的风险比（hr）。作为次要终点，心血管事件被评估。结果：在16778例体弱和10069例非体弱患者中，体弱与较高的死亡率和较短的预期寿命相关。体弱和非体弱患者在缺血性卒中后的死亡率分别为66%和55%，TIA后的死亡率分别为54%和36%。缺血性卒中后的预期寿命分别为3.8年和5.2年，TIA后的预期寿命分别为5.9年和6.4年。缺血性卒中后虚弱与死亡率相关的调整hr为1.30，TIA后为1.72。心血管事件在虚弱患者中更为常见：缺血性卒中后为40%对38%，TIA后为18%对13%。结论：虚弱与卒中或TIA后长期死亡率增加和预期寿命缩短有关。这些发现可能支持治疗决策和高级护理计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.