Journal of the American Heart Association · Jul 31, 2026

Frailty and 1-Year Prognosis of Patients With Ischemic Stroke: A Multicenter Cohort Study

By Xu J, Hu X, Huang X et al.

BACKGROUND: Frailty is a multidimensional geriatric syndrome characterized by reduced physiological reserve and is consistently associated with adverse outcomes in cardiovascular diseases. Frailty has also been linked to poor short-term prognosis in cerebrovascular disease. However, its association with long-term functional recovery and stroke recurrence remains insufficiently established in large prospective cohorts. METHODS: We conducted a cohort study using data from the Impairment of Cognition and Sleep Study of the China National Stroke Registry III. Frailty was assessed at baseline using a deficit accumulation frailty index and categorized as robust, pre-frail, or frail. Primary outcomes were 1-year excellent functional outcome (modified Rankin Scale 0-1), favorable functional outcome (modified Rankin Scale 0-2), and stroke recurrence. Secondary outcomes were corresponding outcomes at 3 and 6 months. Associations were evaluated using multivariable logistic and Cox regression models. RESULTS: Among 2396 patients, 65.3% were robust, 18.0% pre-frail, and 16.7% frail. Increasing frailty severity was independently associated with lower odds of 1-year excellent functional outcome (pre-frail: odds ratio [OR], 0.6; 95% CI, 0.4-0.8; frail: OR, 0.2; 95% CI, 0.2-0.3; P for trend <0.001). Frail patients also had higher stroke recurrence risk (hazard ratio [HR], 1.90; 95% CI, 1.33-2.71) and lower likelihood of favorable functional outcome. Similar dose-response relationships were observed at 3 and 6 months, with consistent findings in sensitivity and subgroup analyses. CONCLUSIONS: Frailty is common after acute ischemic stroke and shows a strong, graded association with 1-year functional recovery, supporting its potential value for long-term prognostic stratification beyond age and comorbidity burden.

doi.org/10.1161/jaha.126.050186 Open access PubMed 42535524 Biomarkers