Frailty Modifies the Prognostic Effect of Age Among Older Adults With Acute Coronary Syndrome

Q: What are the key findings of this study?

In nonfrail older adults with acute coronary syndrome, age ≥75 years was associated with a 2.18-fold higher odds of adverse outcomes compared to those aged <65 years.

Q: What does this research mean for the field?

In nonfrail older adults with acute coronary syndrome, age ≥75 years is associated with a 2.18-fold higher odds of adverse outcomes compared to those aged <65 years. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Q: What question did this study set out to answer?

To evaluate the predictive value of different age groups for adverse clinical outcomes in acute coronary syndrome while accounting for patient frailty status.

Boris Fishman; Amitai Segev; Saar Ashri; Tsahi T. Lerman; Shani Sultani; Roy Beigel; A. Grupper; Fernando Chernomordik; Romana Herscovici; Adi Vinograd; Shauna Assadzandi; Karen Glasser Scandrett; Daniel E. Forman; Shlomi Matetzky

doi:10.1161/jaha.124.040688

December 30, 2025Journal of the American Heart AssociationOpen Access

Frailty Modifies the Prognostic Effect of Age Among Older Adults With Acute Coronary Syndrome

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Key result

Age ≥75 linked to ~118% higher odds of adverse outcomes vs <65 in nonfrail ACS.

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Why the study?

Older adults hospitalized in cardiac intensive care units have complex profiles and frailty affecting outcomes, but definitions of older age lack consensus, warranting evaluation of age groups while accounting for frailty.

Does frailty modify the prognostic effect of age on adverse outcomes in older adults with acute coronary syndrome?

Key Points

To evaluate the predictive value of different age groups for adverse clinical outcomes in acute coronary syndrome while accounting for patient frailty status.
Analyzed prospective registry data of 4790 consecutive patients hospitalized with acute coronary syndrome in a tertiary cardiac intensive care unit between January 2014 and March 2022.
Categorized patients into three age brackets (<65, 65–74, and ≥75 years) and evaluated frailty using the routinely collected Norton score (frail defined as ≤17).
Assessed a composite primary outcome of 90-day all-cause death, shock, acute heart failure, acute kidney injury, stroke, mechanical ventilation, and ventricular arrhythmias using multivariable logistic regression.
Across the entire cohort, 1137 (24%) patients experienced primary outcome events, occurring in 16% of nonfrail patients (3915 [81.7%]) compared with 60% of frail patients.
In nonfrail individuals, advanced age significantly increased risk: adjusted OR for age ≥75 years was 2.18 (95% CI, 1.69–2.81) versus <65 years and 1.46 (95% CI, 1.15–1.85) versus 65–74 years, while age 65–74 years had an adjusted OR of 1.49 (95% CI, 1.16–1.91) versus <65 years.
In frail patients, chronological age showed no significant association with the primary outcome across any age group, including an adjusted OR of 0.76 (95% CI, 0.48–1.19) for ages 65–74 years compared with ≥75 years.

Structured PICO

Does frailty modify the prognostic effect of age on adverse outcomes in older adults with acute coronary syndrome?

P

Population

4,790 consecutive adult patients (aged ≥18 years) admitted to the cardiac intensive care unit with a primary diagnosis of acute coronary syndrome, median age 65, 22.7% female, single-center (Israel).

O

Outcome

Composite of 90-day all-cause death, shock, acute heart failure, acute kidney injury, stroke, mechanical ventilation, and ventricular arrhythmiascomposite

Frailty modifies the prognostic effect of age in ACS patients, serving as a stronger predictor of adverse outcomes than chronological age in the cardiac intensive care unit.

Limitations

Potential unmeasured confounding such as socioeconomic factors, baseline cognitive and functional status, and medical compliance
Undocumented comorbidities and their level of control
Single-center study, potentially poorly representing some ethnicities like East Asians
Frailty evaluated during acute illness rather than in a chronic state

Implication

Age ≥75 linked to worse ACS outcomes only if nonfrail; leaves open frailty-stratified risk models in cardiac ICU.

Abstract

Background An increasing number of older adults have been hospitalized in cardiac intensive care units. Their more complex medical profiles and frailty dictate treatment decisions and affect outcomes. There is no universally agreed‐upon age definition for an older adult, with common thresholds being 65 or 75 years. Our objective was to evaluate the predictive value of various age groups while accounting for frailty. Methods In this observational cohort study, we analyzed data from a prospective registry of consecutive patients admitted to the cardiac intensive care unit at a tertiary hospital between January 2014 and March 2022 with a diagnosis of acute coronary syndrome. The primary outcome was the composite of 90‐day all‐cause death, shock, acute heart failure, acute kidney injury, stroke, mechanical ventilation, and ventricular arrhythmias. Frailty was dichotomized using the routinely measured Norton score for all inpatients; a ≤17 score was defined as frail. Results The study included 4790 patients with acute coronary syndrome, divided into age groups: 2249 aged <65 years, 1294 aged 65 to 74 years, and 1247 aged ≥75 years, with a higher proportion of women in the older age groups. Due to the interaction between age and frailty, the cohort was divided and analyzed separately on the basis of frailty status. Among the nonfrail group (3915 [81.7%]), 16% reached the outcome. Adjusted odds ratios for the primary outcome in patients aged ≥75 years were 2.18 (95% CI, 1.69–2.81) and 1.46 (95% CI, 1.15–1.85) compared with those aged <65 years and 65 to 74 years, respectively. For patients aged 65 to 74 years compared with those <65 years, the odds ratio was 1.49 (95% CI, 1.16–1.91). In the frail group, where 60% reached the outcome, no significant association was found between age groups and outcomes. Conclusions Our results suggest that frailty may be a surrogate for aging and is a stronger predictor than chronological age for adverse outcomes among patients with acute coronary syndrome in the cardiac intensive care unit.

Discussion

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Cite This Study

Fishman et al. (2025) studied this question. In nonfrail older adults with acute coronary syndrome, age ≥75 years was associated with a 2.18-fold higher odds of adverse outcomes compared to those aged <65 years.

synapsesocial.com/papers/6963220c91e05aa366cb8797 https://doi.org/10.1161/jaha.124.040688

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Frailty Modifies the Prognostic Effect of Age Among Older Adults With Acute Coronary Syndrome

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Frailty Modifies the Prognostic Effect of Age Among Older Adults With Acute Coronary Syndrome

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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