Prevalence of frailty in the TIA 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 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 two weeks of clinic were included. Prevalence of frailty was determined based on CFS score >4. Hazard ratios (HR) 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 1185 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: 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%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]). Of 414 patients with repeat CFS, median interval 15 months, median change was +1 point (IQR:0-2). Conclusion Frailty is common in TIA and becomes more common following TIA. Strength of 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.