A retrospective, multicenter analysis demonstrates how frailty and age independently predict death in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS). Wasim Ahmadzai, MD, from Rigshospitalet in Copenhagen, Denmark, and colleagues, reported these results in a manuscript published online in JACC: Advances. Dr. Ahmadzai told CRTonline about the study’s conclusions. “The findings come from Denmark’s universal, publicly funded healthcare system, where access to advanced cardiac care is broad, suggesting that frailty remains a key prognostic factor even when barriers to treatment are low - though confirmation in other settings and in an evolving data landscape remains important,” he said. Patients who have acute myocardial infarction (AMI) sometimes develop cardiogenic shock. This complication is serious and has a mortality rate of 50%. Frailty makes patients have worse outcomes in general, but the impact of frailty on AMICS is not well understood. The investigators in this study examined the effects of frailty and age on rates of death in patients with AMICS. “Importantly, these associations were demonstrated in a group of patients with an extremely poor prognosis, where treatment choices often involve difficult discussions about potential benefit, futility, and resource use among clinicians, patients, their relatives, and society,” Dr. Ahmadzai explained to CRTonline. The RETROSHOCK cohort was used for data collection in this study. A total of 1,716 patients with AMICS were admitted to 2 tertiary university hospitals in Denmark between 2010 and 2017. The Hospital Frailty Risk Score was used to assess frailty levels. Frailty was defined as a score ≥5. Patients were also stratified by age (≥70 years old and <70 years old). In a different analysis, patients were divided into 5 age groups at 10-year intervals. Mortality was assessed at follow-ups of 30 days, 1 year and 10 years. A total of 381 patients in this cohort were frail (median age=69.5 years). At 30-days, mortality rates were higher in frail patients (65%) compared with nonfrail patients (51%) (p<0.001). Patients ≥80 years old had the highest mortality rates (82%, p<0.001) at 30-days compared with patients under 50 years old (adjusted hazard ratio [HR]=9.18, 95% confidence interval [CI]=4.66-18.1, p<0.001). When age and frailty were combined for analysis, frail patients had a 73% mortality rate at 30-days when they were 70 years of age or older. At 10-year follow-up, this rate was 82%. Overall, frailty was an independent risk factor for mortality in patients with AMICS. “These results highlight the need to consider frailty alongside age when treating critical-care patients to support complex decisions in real time,” Dr. Ahmadzai said. “One could also make the point that, because registry-based frailty scoring can be performed at scale using routinely collected data, these findings are relevant to the design, eligibility criteria, and outcome analyses of future clinical trials.” Source: Ahmadzai MW, Kunkel JB, Graversen PL, et al. Frailty and age as predictors of mortality in acute myocardial infarction complicated by cardiogenic shock. JACC Advances. 2025 September 17 (Article in press). Image Credit: AnnaStills – stock.adobe.com