Frail, older patients have 50% increased risk of bleeding during hospitalisation for myocardial infarction

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John A Dodson (New York University School of Medicine, New York, USA) and others report in JACC: Cardiovascular Interventions that patients over age 65 who are frail had a 50% higher risk of major bleeding when hospitalised during a myocardial infarction than non-frail patients. This risk was seen in frail patients who underwent cardiac catheterisation but not those who were managed with medications alone.

The authors analysed data for 129,330 acute myocardial infarction patients over 65 years of age from 775 US hospitals between January 2015 and December 2016. They found that patients with an acute myocardial infarction who were frail were: more likely to be female; 50% more likely to experience major bleeding; less likely overall to undergo cardiac catheterisation; less likely to receive radial access when cardiac catheterisation was performed; and at higher risk of bleeding when cardiac catheterisation was performed but not when treated with medications alone.

In the study, frail was classified based on three impairment domains: walking (unassisted, assisted, wheelchair/non-ambulatory), cognition (normal, mildly impaired, moderately/severely impaired), and basic activities of daily living (bathing, eating, dressing, and toileting). Although some smaller studies have looked at frailty in relationship to myocardial infarction and bleeding, this is the first study to gather data from the ACTION Registry—now known as the Chest Pain-MI Registry.

Dodson comments: “As the US population ages, there is an increasing number of older people who are experiencing acute myocardial infarction—and often they are managing other health problems at the same time. Our findings highlight that frailty is an important variable to consider when managing these patients, beyond the characteristics we traditionally use. We need to look even more closely at evidenced-based clinical strategies to avoid bleeding in this population.”

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