Prevalence of Frailty in the Transient Ischaemic Attack Clinic and Its Associations with Mortality

Introduction: Frailty is a clinical syndrome of increased vulnerability to stressors. Frailty is associated with adverse outcomes after stroke, but frailty and transient ischaemic attack (TIA) are less well described.

Methods: We conducted a retrospective analysis of patients referred by the emergency department (ED) to TIA clinic (01/01/2016-12/03/2022) linked to hospital records for electronic follow-up. Only those with Clinical Frailty Scale (CFS) recorded within 2 weeks of clinic were included. Prevalence of frailty was determined based on CFS score ≥4. Hazard ratios (HRs) for mortality were determined through Cox proportional hazard regression, adjusted for prognostic factors. Where repeat CFS data were available, temporal change in frailty was recorded (∼15 months).

Results: Of 1,185 patients included, 53.5% (n = 634) had frailty. Patients with frailty tended to be older (median age 81 vs. 74 years, p < 0.001) and female (53.9% vs. 39.9% p < 0.001). Of 335 diagnosed with TIA following review, 61.2% (n = 205) were frail. Prevalence of frailty by clinic diagnosis was as follows: TIA 61.2% (205/335), stroke 46.7% (128/274), other diagnoses 52.3% (301/575). In TIA patients and the whole cohort (WC), frailty (TIA: HR: 2.69 [95% confidence interval (CI): 1.23-5.87, p = 0.013], WC: 2.58 [95% CI: 1.64-4.08, p < 0.001]), and increasing age [HR: 1.07 95% CI: 1.04-1.12] were predictive of mortality. In stroke patients, only increasing age was predictive of death (HR: 1.11 [95% CI: 1.04-1.19, p = 0.003]). For 414 patients with repeat CFS, the median interval was 15 months and the median change was +1 point (inter-quartile range: 0-2).

Conclusion: Frailty is common in TIA and becomes more common following TIA. The strength of the association of frailty with poor outcome was greater for TIA patients than for those with stroke. Routine assessment of frailty may be a useful addition to TIA services.