Should octogenarians and people aged 90 years and over be treated separately in studies of stroke? An evaluation of national audit data

Introduction Population studies frequently use ≥80 years for defining ‘very old’ but as mean life expectancy frequently exceeds 80 years internationally, this may no longer be appropriate. Those ≥90 years now represent a significant proportion of stroke patients. We examined national data to examine the differences between those 80–89 years and those 90+ years. Methods Data from the Irish National Audit of Stroke (2017–22 inclusive), including demographic, admission and outcome data, including prestroke and discharge modified Rankin Scores (mRS), were analysed. Proportional data were analysed using Chi-square statistics. Results Data on 26 829 individual stroke events were analysed of which 7329 (27.3%) were in people 80–89 years; 52.8% were women. 1708 events occurred in people ≥90 (6.4%); 70.0% were women. 73.7% of those 80–89 years had mRS < 3 prestroke vs 51.3% of those ≥90 (P < .001). In hospital mortality for people ≥90 was higher (26.8% vs 17.4% P < .001) and they were less likely to have mRS < 3 at discharge (17.0% vs 35.8% P < .001). Proportion of haemorrhagic stroke was significantly lower in those ≥90 (15.3% vs 12.9% P = .015). Only one haemorrhage was reported amongst 31 people ≥100 years. The proportion of atrial fibrillation (AF) detected following stroke was not significantly different (≥90 years: 33.9%, 80–89 years, 32.4% P = .38). On logistic regression, nonrecovery to independence (mRS >2) in those ≥90 was associated with prestroke mRS, haemorrhagic stroke, AF and being thrombolysed. Conclusion There are differences in profiles and outcomes between the groups, and it is now more appropriate to consider them separately.