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Frailty and long-term outcomes in younger patients with acute myocardial infarction
Hasan Mohiaddin1,2, Shirley Sze1, Abdulla A Damluji3,4
1NIHR Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
Insights
Frailty significantly increases mortality risk after acute myocardial infarction (AMI). Younger patients with severe frailty face the highest mortality risk, underscoring the need for frailty assessment in all age groups.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Frailty is a known predictor of adverse outcomes in older adults with acute myocardial infarction (AMI).
- The impact of frailty on younger AMI patients remains understudied.
- This study investigates frailty's effect on AMI outcomes across different age strata.
Purpose of the Study:
- To assess the association between frailty and adverse outcomes in patients with acute myocardial infarction (AMI).
- To stratify the impact of frailty by age groups.
- To determine if frailty affects younger AMI patients differently.
Main Methods:
- A population-based epidemiological study using linked national administrative data from England and Wales.
- Patients were categorized into three age groups: <55, 55-74, and ≥75 years.
- Frailty was measured using the Secondary Care Administrative Records Frailty index, classifying patients as fit, mild, moderate, or severe. All-cause mortality at 1 year was the primary outcome.
Main Results:
- Severely frail patients constituted 13% of the 931,133 individuals studied.
- Severe frailty was associated with significantly higher adjusted hazard ratios for 1-year all-cause mortality across all age groups.
- Younger patients (<55 years) with severe frailty exhibited the highest mortality risk (aHR 6.69), with a 3.51-fold increased risk compared to older severely frail patients.
Conclusions:
- Frailty is an independent predictor of poor outcomes following acute myocardial infarction (AMI).
- The detrimental impact of frailty on mortality is most pronounced in younger AMI patients.
- Routine frailty assessment is recommended for all patients diagnosed with AMI, irrespective of age.
Background And Aims:
Frailty is increasingly recognized as an important determinant of adverse outcomes in older adults with acute myocardial infarction (AMI), but its impact in younger patients remains underexplored. The aims of this study were to evaluate the association of frailty with adverse outcomes in AMI patients, stratified by age.
Methods:
This population-based epidemiological study utilized linked national administrative data from England and Wales. Patients were stratified into three age groups: <55 years, 55-74 years, and ≥75 years. Frailty was assessed using the Secondary Care Administrative Records Frailty index with patients categorized into fit, mild, moderate, and severe groups. All-cause mortality at 1 year was the primary outcome. Secondary outcomes were cardiovascular and bleeding-related events.
Results:
A total of 931 133 patients were included of which 13% of patients were severely frail. In patients with severe frailty, adjusted hazard ratios for all-cause mortality were 6.69 [95% confidence interval (CI) 5.76-7.76] for young patients, 4.33 (95% CI 4.11-4.57) for middle-aged patients, and 2.31 (95% CI 2.23-2.39) for older patients. The interaction between age and frailty revealed that younger patients with severe frailty had a 3.51-fold (95% CI 3.11-3.96) higher risk of all-cause mortality compared with older patients with severe frailty (P < .001).
Conclusions:
Frailty is independently associated with poor outcomes after AMI, with the strongest impact observed in younger patients, highlighting the need for frailty assessment across all age groups.
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