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

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: 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.