TOPLINE:

Among patients with acute myocardial infarction (MI), frailty was associated with an increased risk for all-cause mortality at 1 year across all age groups. The impact was more pronounced in patients younger than 55 years, particularly among those with severe frailty.

METHODOLOGY:

• This population-based study evaluated whether age modified the impact of frailty on the risk for adverse outcomes after acute MI.
• Investigators used linked datasets from England and Wales to include 931,133 adults hospitalized with acute MI between January 2005 and March 2019; 34.1% of patients were female.
• Patients were stratified into three age groups: younger than 55 years (17%), 55-74 years (44%), and 75 years or older (39%).
• Frailty was measured using the Secondary Care Administrative Records Frailty index, and patients were categorized as fit or as having mild, moderate, or severe frailty.
• The primary outcome was all-cause mortality at 1 year. Secondary outcomes included cardiovascular and bleeding-related events.

TAKEAWAY:

• Overall, 36% of patients had mild frailty, 22% had moderate frailty, 13% had severe frailty, and 29% were fit. Severe frailty was more common with increasing age.
• Patients with severe frailty had a significantly higher risk for all-cause mortality — 6.69-fold in those younger than 55 years, 4.33-fold in those aged 55-74 years, and 2.31-fold in those aged 75 years or older — than fit patients in the same age group.
• Among patients with severe frailty, those younger than 55 years had a 3.51-fold higher risk for mortality than those aged 75 years or older (P < .001), with similar patterns across secondary outcomes.
• Among those who died within 1 year, years of life lost were the highest in patients younger than 55 years with severe frailty.

IN PRACTICE:

“This striking disparity underscores the importance of incorporating robust frailty assessment into routine AMI [acute MI] care, even for younger patients,” the investigators of this study wrote. “This underscores that for young, severely frail patients, chronological age alone is an insufficient marker of their true underlying vulnerability and significantly higher-risk profile.”

SOURCE:

This study was led by Hasan Mohiaddin, University of Leicester, Glenfield Hospital, Leicester, England. It was published online on November 25, 2025, in the European Heart Journal.

LIMITATIONS:

This epidemiologic study used data from administrative registries; thus, it identified associations rather than cause-effect relationships. Some confounding factors may not have been captured, even after adjustments. Frailty was measured with a database-driven index rather than clinical tools.

DISCLOSURES:

Two authors reported receiving funds from the National Institute for Health and Care Research, and one of them also reported receiving funds from the Development and Skills Enhancement award and an Academy of Medical Sciences grant. One author disclosed serving as a consultant for multiple pharmaceutical, biotechnology, medical device, and healthcare companies, including AstraZeneca, Roche, and Medtronic.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.