Frailty increases 2-year mortality risk across all age groups post-first MI, e.g., under 65: 11.88% vs 3.65%, and frail patients receive less guideline therapy.
Does frailty increase 2-year mortality risk and reduce the likelihood of receiving guideline-recommended therapy in patients with first-time myocardial infarction across different age groups?
Frailty independently exacerbates mortality risk and reduces the likelihood of receiving guideline-recommended therapy in patients with first-time MI, with a frail 40-year-old having a mortality risk comparable to a non-frail 70-year-old.
Absolute Event Rate: 0% vs 0%
Abstract Background While aging and frailty are frequently used interchangeably in cardiovascular research, they have distinct clinical implications. While aging is an inevitable biological process, frailty reflects a stage of increased vulnerability, independent of age. To improve patient outcomes, it is crucial to distinguish the independent effects of aging and frailty on patient treatment and mortality. Purpose This study investigated the impact of frailty on the interaction between age and mortality among patients with a first-time myocardial infarction (MI) from 2013-2022. Additionally, it explored how frailty influenced treatment patterns across age groups. Methods All patients ≥30 years with a first-time MI between January 1st, 2013, and December 31st, 2022, were identified through Danish nationwide registries. Patients were stratified into three age groups (‘ 65 years’, ‘65-79 years’, and ‘≥80 years’), and then classified as either frail or non-frail. The initiation of guideline-recommended therapy for MI and the 2-year mortality risk, in frail and non-frail patients within each age group, were analyzed using Kaplan Meier estimates and multivariable Cox regression. Results A total of 55,777 patients were included, with 24,305 patients aged 65, 21,480 patients aged 65-79, and 9992 patients aged ≥80. Across all age groups, frail patients exhibited an increased 2-year absolute risk (AR) of mortality, when compared to non-frail patients; for those aged 65 (AR mortalityFrail 11.88% 95% CI 10.27-13.48 vs. AR mortalityNon-frail 3.65% 95 % CI 3.40-3.89; for those aged 65-79 (AR mortalityFrail 28.14% 95% CI 26.46-29.83 vs. AR mortalityNon-frail 10.31% 95 % CI 9.87-10.75; and for those aged ≥ 80 AR mortalityFrail 52.58% 95% CI 50.67-54.49 vs. AR mortalityNon-frail 31.58% 95 % CI 30.51-32.66. Increasing age was associated with increased mortality, but frailty further exacerbated this risk across all age groups, with a lower interaction as age increased. Further, the 2-year mortality risk of a frail 40-year old with a first-time MI was comparable to that of a non-frail 70-year old (figure 1). Across all age groups, frail patients were significantly less likely to receive guideline-recommended therapy, when compared to non-frail patients (figure 2). Conclusion In patients experiencing their first MI, the relationship between aging and mortality risk exhibited a curvilinear pattern, with a notable increase in risk around the age of 75 years. Frailty exacerbated this risk, following a parallel trajectory, though its impact diminished in the very elderly patients. Regardless of age, frail patients were less likely to receive guideline-recommended therapies.Mortality according to age and frailty Treatment according to age and frailty
Friis et al. (Sat,) reported a other. Frailty increases 2-year mortality risk across all age groups post-first MI, e.g., under 65: 11.88% vs 3.65%, and frail patients receive less guideline therapy.