Sex–specific associations between frailty and long-term outcomes in patients with acute myocardial infarction: a national population-based study

IF 15.7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2026-05-01 Epub Date: 2026-02-12 DOI:10.1016/j.lanepe.2026.101612

Hasan Mohiaddin , Chijioke Horatio Mosanya , Claire Lawson , Kamlesh Khunti , Angela Wood , Iain B. Squire , Gerry P. McCann , Abdulla A. Damluji , Sergio Buccheri , Mohamad A. Alkhouli , Mamas A. Mamas , Muhammad Rashid

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引用次数: 0

Abstract

Background

Frailty and female sex are both recognised independent predictors of adverse outcomes after acute myocardial infarction (AMI). While females presenting with AMI are known to have a higher burden of frailty than males, it is unknown whether this fully explains sex-based disparities in outcomes, or if the prognostic impact of frailty itself differs between the sexes.

Methods

We conducted a retrospective national cohort study using data from the Myocardial Ischaemia National Audit Project (MINAP), linked to hospital admission and mortality registries in England and Wales between 2005 and 2019. Frailty was assessed using the Secondary Care Administrative Records Frailty (SCARF) index and categorised as fit, mild, moderate, or severe. Multivariable Cox proportional hazards models were used with a primary outcome of all-cause mortality at 1-year.

Findings

Of 931,133 patients with AMI, 317,967 (34.1%) were female. Frailty was more prevalent in females than in males (severe frailty: 53,065 [16.7%] vs. 64,018 [10.4%]). Males received more intensive therapeutic care across all frailty levels. After multivariable adjustment, the relationship between severe frailty and 1-year all-cause mortality was 26% greater in males than in females (relative hazard ratio [rHR]: 1.26, 95% CI 1.19–1.32, P-interaction <0.001). This corresponded to an adjusted absolute risk difference of 1.19% (95% CI 0.58%–1.79%)

Interpretation

In this national AMI cohort, while frailty was more prevalent in females, its association with 1-year mortality was significantly greater in males. This sex-specific effect of frailty challenges current risk-assessment paradigms and underscores the need for sex-informed care pathways.

Funding

National Institute for Health and Care Research and British Heart Foundation Centre of Research Excellence, Leicester.

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急性心肌梗死患者虚弱和长期预后之间的性别特异性关联：一项基于全国人群的研究

背景：虚弱和女性都是公认的急性心肌梗死（AMI）后不良结局的独立预测因素。虽然已知患有AMI的女性比男性有更高的虚弱负担，但尚不清楚这是否完全解释了基于性别的结果差异，或者是否虚弱本身的预后影响在性别之间存在差异。方法：我们使用心肌缺血国家审计项目（MINAP）的数据进行了一项回顾性国家队列研究，该研究与2005年至2019年英格兰和威尔士的住院和死亡率登记有关。使用二级保健行政记录虚弱（SCARF）指数对虚弱进行评估，并将其分为适合、轻度、中度或重度。采用多变量Cox比例风险模型，主要结局为1年全因死亡率。931,133例AMI患者中，女性317,967例（34.1%）。虚弱在女性中比在男性中更为普遍（严重虚弱：53065例[16.7%]对64018例[10.4%]）。男性在所有虚弱程度上都接受了更多的强化治疗。多变量调整后，男性严重虚弱与1年全因死亡率之间的关系比女性高26%（相对危险比[rHR]: 1.26, 95% CI 1.19-1.32, P-interaction <0.001）。这对应于调整后的绝对风险差为1.19% （95% CI 0.58%-1.79%）。在这个全国性AMI队列中，虽然虚弱在女性中更为普遍，但其与男性1年死亡率的关联明显更大。这种脆弱的性别特异性影响挑战了当前的风险评估范式，并强调了性别知情的护理途径的必要性。国家健康与护理研究所和英国心脏基金会卓越研究中心，莱斯特。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.