Scientific title:
The Frailty and Its Effect on Stroke Treatments and Outcomes (FIESTO) Programme
University of Cambridge
Principal investigator:
Dr Nicholas Evans
Grant value:
Research ID:
SA SCL MED 22\100006
Research area:
Start date:
Saturday 1 April 2023
End date:
Friday 31 March 2028
5 years
Year awarded:

Why is this research needed?

Thrombolysis (clot-busting drugs) and thrombectomy (mechanical clot removal) are game-changing emergency treatments for stroke, and we're proud to have funded research that has led to their widespread use in the UK.

However, not everyone is able to benefit from these treatments. One reason why someone might not be offered these treatments is that they are frail. In a medical context, frailty is our ability to withstand and recover from illnesses. However, we don't have a good idea of how different levels of frailty might impact on what someone needs and how well they will respond when it comes to stroke treatments. 

What are the aims of this research?

Nick will focus on how frailty affects people's response to thrombectomy and thrombolysis. Throughout, he will be working with people affected by stroke to make sure his research and his findings are addressing their needs, building a regional network of survivors, carers, researchers and healthcare professionals who can help guide future research.

He will use brain imaging to get a better understanding of what is happening in the brains and blood vessels of people with different levels of frailty. The programme will investigate how such differences may affect a person's response to thrombolysis, thrombectomy, and other acute stroke treatments.

To understand how this may benefit people affected by stroke, Nick will gather information from hospitals across the East of England to investigate what factors influence how well someone responds to stroke treatment. He will also be asking stroke healthcare professionals about their opinions about frailty before and after he's published the results of this part of the research project to see what effects it has had on the decisions they make about stroke treatment.

Alongside this, he will run a clinical trial to see whether the drug sodium valproate can help remove fatty plaques from the brain's blood vessels. These plaques are currently only treatable with surgery, which isn't a safe option for everyone, particularly those with higher levels of frailty.

Finally, Nick will trial a frailty intervention programme, for people who have mild levels of frailty and have had a recent stroke. This will be co-designed with people affected by stroke and will include elements like physical and mental activities, nutrition, and social support. He will test its effectiveness by looking at a variety of measures related to health and quality of life.

What is the benefit of this research?

Frail people are often excluded from research, which can lead to a vicious circle: we don't know what treatments are safe and effective for them, and we can't find out. Nick's project breaks this circle by actively including frail stroke survivors in research on acute care and rehabilitation.

He may find that these treatments are safe and effective even for frail people, in which case he will be able to share the evidence with other clinicians and change treatment practices, potentially increasing the number of individuals who may benefit from these treatments.

Alternatively, Nick may find that thrombectomy and thrombolysis are not safe or are less effective for frail stroke patients, confirming the current approach to acute stroke care. In that case, we can look for alternative treatments or find ways to modify the existing treatments, so they work better for frail people. His frailty intervention programme could also help frail stroke survivors make better recoveries even if they aren't able to have thrombectomy or thrombolysis.

Nick says, 'I've seen first-hand how research has advanced stroke care. As a medical student, I remember seeing people admitted to hospital with strokes where there was a feeling that nothing could be done. Since then, we've made great progress across all aspects of stroke care, but there is still lots to be done. It is an exciting time to be in stroke research, with great promise to be able to make a real impact on improving life after stroke.'

What PSP priorities does this research link to?

From 2019 to 2021, we worked with the James Lind Alliance on the Stroke Priority Setting Partnership (PSP). During the PSP process, we collaborated with people with lived experience of stroke and stroke professionals to find out what they thought were the top priorities in stroke research. From this, we identified the top ten priorities in two areas: prevention, diagnosis and short-term care, and rehabilitation and long-term care.

Now, when a researcher applies to us for funding, we require that their work addresses at least one of these priorities.

Nick's project addresses the following priorities:

  • Prevention 10: Effects of other health conditions and characteristics on stroke.
  • Rehabilitation 9: Strength and fitness for recovery and stroke prevention.

You can learn more about how the PSP worked and get a full list of stroke research priorities on the Stroke Priority Setting Partnership page.

Meet the researcher

Nick is a Consultant Stroke Physician at Addenbrooke's Hospital (Cambridge University Hospitals NHS Trust) and a Senior Clinical Lecturer at the University of Cambridge.

Nick says, 'I have been very fortunate to have had inspiring mentors in both my research and clinical careers to date. I hope to follow in their footsteps; training future clinicians and clinical academics working in stroke medicine. The support from the Stroke Association has enabled me to develop as a researcher and to start leading my own team of researchers.'