Hospital Frailty Risk Score (HFRS) in ischemic stroke

Abstract

Background & Objective: Frailty results from an age-associated decline in physiological reserve and function and is prevalent in older adults. In this retrospective cohort study, we aimed to validate the Hospital Frailty Risk Score (HFRS) in predicting adverse events and hospitalisation utilisation in older patients hospitalised with ischemic stroke and hypothesise that frailty is a comparable predictor of adverse outcomes in stroke.

Methods: Older patients aged 65 years and above with ischemic stroke admitted to a tertiary hospital in Singapore from 1st January 2019 to 31st December 2019 were identified and categorised into high risk (>15), intermediate risk (5-15) and low risk (<5) of frailty using HFRS.

Results: A total of 1,023 patients with ischemic stroke were included in this study. HFRS was categorised as high risk in 271 patients (26.5%), intermediate risk in 544 patients (53.2%) and low risk in 208 patients (20.3%). Patients with higher HFRS scores were older, more likely female, have lower BMI and more comorbidities. Higher HFRS scores was also associated with increased length of stay, 90 day and 1 year mortality, but not 30-day readmission and inpatient mortality. Predictive models which incorporated HFRS and other relevant variables showed good predictive value for long length of stay and 1 year mortality with AUC of 0.811 (0.744 – 0.878) and 0.749 (0.619 – 0.878) respectively.

Conclusion: Our study has shown that patients with high risk of frailty have higher healthcare utilisation than low risk patients. Identification of frailty can help stratify care for older frail patients.