Treatment-modifying effects of frailty on stroke reperfusion therapy outcomes: a systematic review and meta-analysis.
Background Frailty is common amongst individuals presenting with acute ischaemic stroke (AIS). Not only has frailty been found to have disease-modifying effects in terms of survival and disability after AIS, but it may also exert a treatment-modifying effect in reperfusion therapies. However, studie...
| Published in: | Age & Ageing Vol. 55; no. 4; pp. 1 - 11 |
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| Main Authors: | , , , , |
| Format: | Article |
| Published: |
Oxford University Press / USA
Apr2026
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| Subjects: | |
| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=193500077&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 193500077 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Apr2026 vid: 55 iid: 4 pid: 622 pub: Oxford University Press / USA artinfo: ui: 193500077 10.1093/ageing/afag080 ppf: 1 ppct: 10 formats: tig: atl: Treatment-modifying effects of frailty on stroke reperfusion therapy outcomes: a systematic review and meta-analysis. aug: au: Varma, Anakha Bhakta, Shiv Dohle, Esmee Warburton, Elizabeth Evans, Nicholas R affil: Department of Clinical Neurosciences, University of Cambridge, Cambridge, England, United Kingdom of Great Britain and Northern Ireland su: Diseases Mortality risk factors Risk assessment Medical information storage & retrieval systems Acute diseases Research funding Thrombolytic therapy Decision making in clinical medicine Treatment effectiveness Meta-analysis Descriptive statistics Systematic reviews MEDLINE Ischemic stroke Reperfusion Online information services Data analysis software Confidence intervals Thrombectomy sug: subj: Diseases Mortality risk factors Risk assessment Medical information storage & retrieval systems Acute diseases Research funding Thrombolytic therapy Decision making in clinical medicine Treatment effectiveness Meta-analysis Descriptive statistics Systematic reviews MEDLINE Ischemic stroke Reperfusion Online information services Data analysis software Confidence intervals Thrombectomy keyword: acute cerebrovascular accidents acute ischaemic stroke cerebrovascular accident copyrightHolder:British Geriatrics Society copyrightYear:2026 frailty https://dx.doi.org/10.1093/ageing/afag080 inLanguage:en ischemic stroke mortality older people outcomes publisher:Oxford University Press reperfusion therapy sameAs:https://pubmed.ncbi.nlm.nih.gov/41965254/ systematic review thrombectomy thrombolysis thrombolytic therapy acute cerebrovascular accidents acute ischaemic stroke cerebrovascular accident copyrightHolder:British Geriatrics Society copyrightYear:2026 frailty https://dx.doi.org/10.1093/ageing/afag080 inLanguage:en ischemic stroke mortality older people outcomes publisher:Oxford University Press reperfusion therapy sameAs:https://pubmed.ncbi.nlm.nih.gov/41965254/ systematic review thrombectomy thrombolysis thrombolytic therapy ab: Background Frailty is common amongst individuals presenting with acute ischaemic stroke (AIS). Not only has frailty been found to have disease-modifying effects in terms of survival and disability after AIS, but it may also exert a treatment-modifying effect in reperfusion therapies. However, studies investigating this to date have frequently been of limited sample size, highlighting the potential for meta-analysis to definitively establish any treatment-modifying effect. Objectives We investigate the effect of pre-stroke frailty on morbidity and mortality outcomes following reperfusion treatment (thrombectomy and thrombolysis) for AIS. Methods A systematic review was performed according to Preferred Reporting of Items in Systematic Reviews and Meta-Analyses guidelines, via searching the EMBASE, PubMed, Scopus and Web of Science databases up to August 2025. Results We identified 11 relevant studies with 194,699 participants. Overall, the prevalence of frailty was 37.2% [frail (n = 72,311), non-frail (122,096)]. Frailty was associated with increased 90-day (RR 2.19 [95% CI 1.44–3.34]) and one-year mortality (RR 2.11 [95% CI 1.6–2.78]), but not with symptomatic intracranial haemorrhage (RR 1.23 [95% CI 0.78–1.96]) or modified Rankin score 3–5 (RR 2.20 [0.94–5.16]). Conclusions Frailty has a consistent association with mortality at different time points after AIS reperfusion therapies. Despite some study heterogeneity, there is evidence that pre-stroke frailty is associated with increased mortality after treatment, though not with increased risks of symptomatic intracerebral haemorrhage or post-stroke disability. These findings suggest that routine pre-morbid frailty assessment may inform the decision-making process for AIS reperfusion treatment administration. This study highlights the need for large multi-centre prospective trials. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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