Frailty in Stroke Care in Germany Between 2016 and 2022-A Retrospective, Hospital-Based Nationwide Cohort Study

This study examines changes in frailty among patients hospitalized for acute ischemic stroke (AIS) in a nationwide hospital cohort in Germany. Data from AIS patients were compared between the period before the corona virus disease 2019 (COVID-19)-pandemic (1 January 2016 to 31 December 2019) vs the pandemic phase (1 January 2020 to 31 December 2022). Frailty was categorized using the Hospital Frailty Risk Score (HFRS). Inferential statistics were conducted using generalized linear mixed models. Among the 101,124 included AIS patients, the median HFRS decreased from 9.3 (interquartile range [IQR]: 5.2-15.5) in pre-pandemic years to 8.4 (IQR: 4.4-14.2) during the pandemic (p < 0.01). Among high frailty AIS patients, length of stay rose from 15.7 (±14.9) to 16.0 (±15.0) days, differing significantly from the decrease observed among low frailty patients from 5.9 (±3.7) to 5.0 (±3.5; p < 0.01) days. Compared to pre-pandemic levels, among low frailty patients, there was a significant increase in rates of thrombolysis (odds ratio [OR] 1.14 [95% CI 1.02-1.28; p = 0.020]) and thrombectomy (OR 1.35 [1.32-1.48; p = 0.047]). In this nationwide study in Germany, there was a longitudinal decrease in frailty among patients hospitalized for AIS which was accompanied by increased rates of thrombolysis and thrombectomy.