Frail patients with first-time myocardial infarction experienced a significantly lower reduction in mortality rates over time compared to non-frail patients (HR 0.63 vs 0.58, interaction P<0.001).
Cohort (n=118,674)
Yes
Do temporal trends in the initiation of guideline-recommended therapy and mortality reductions differ between vulnerable and non-vulnerable patients with first-time myocardial infarction?
Despite overall improvements in MI treatment and mortality from 2003 to 2022, significant disparities persist for vulnerable populations, particularly frail patients who experienced less pronounced mortality reductions.
Hazard Ratio: 0.63 (95% CI 0.59–0.68)
p-value: p=<0.001
Abstract Background Significant advancements in prevention, diagnostics, and clinical management of myocardial infarction (MI) have contributed to an overall decline in MI mortality over the past two decades. While existing literature has largely focused on overall mortality trends, there remains limited understanding of how these trends vary among potentially vulnerable subpopulations that may experience healthcare disparities. Purpose This study examined temporal trends in treatment and mortality among first-time myocardial infarction (MI) patients from 2003-2022 across eight potentially vulnerable subgroups. Methods Patients ≥30 years hospitalized with a first-time MI between January 1st, 2003, and December 31st, 2022, were identified through nationwide Danish registries and divided into eight potentially vulnerable subgroups, along with their counterparts (‘age ≥80’, ‘low income’, ‘female’, ‘frail’, ‘non-Western immigrant’, ‘history of mental illness’, ‘living alone’, and ‘living in a rural area’). Temporal trends in initiation of guideline-recommended therapy and mortality were assessed over five-year calendar periods using Kaplan Meier estimates and multivariable Cox regression. Results A total of 118,674 patients were included. The probability of receiving guideline-recommended therapy increased for most subgroups over time, except for ‘non-Western immigrant’ (ORNon-Western Immigrant 0.95 95% CI 0.77-1.18 for a cardiovascular procedure). Over time, the proportion of treated patients remained significantly lower in most potentially vulnerable groups, compared to their counterparts (figure 1). Crude and adjusted mortality rates declined for all subgroups over time, but with a persistent gap in mortality between most potentially vulnerable subgroups and their counterparts (figure 2). Frail patients exhibited a significantly lower reduction in mortality rates over time, when compared to non-frail patients. (HRFrail 0.63 95% CI 0.59-0.68 vs. HRNon-frail 0.58 95 % CI: 0.55-0.60, interaction p-value 0.001). Conclusion Although there have been advancements in the treatment of patients with first-time MI, with guideline-recommended therapies leading to decreased mortality rates from 2003 to 2022, significant disparities still exist between potentially vulnerable and non-vulnerable groups. Notably, the reduction in mortality rates for frail patients has been considerably less pronounced compared to their non-frail counterparts during this period.Treatment across patient groups Mortality risk across patient groups
Friis et al. (2025) conducted a cohort in first-time myocardial infarction (n=118,674). Vulnerable patient characteristics (e.g., frailty) vs. Non-vulnerable counterparts was evaluated on Mortality reduction over time (HR 0.63, 95% CI 0.59-0.68, p=<0.001). Frail patients with first-time myocardial infarction experienced a significantly lower reduction in mortality rates over time compared to non-frail patients (HR 0.63 vs 0.58, interaction P<0.001).
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