Cardiology

Frailty Multiplies Post-AMI Mortality, Most Dramatically in Patients <55 Years

This nationwide cohort included 931,133 AMI patients stratified into <55, 55–74, and ≥75 years and by frailty category. Severe frailty conferred adjusted 1-year mortality hazard ratios of 6.69, 4.33, and 2.31 in young, middle-aged, and older patients, respectively. Younger severely frail patients had a 3.51-fold higher mortality risk than older severely frail patients with AMI. Frailty independently predicted poor outcomes across all ages, supporting routine frailty assessment and intensified secondary prevention, particularly in younger AMI patients. 1

US Heart Failure Numbers Have Grown, with Rising Metabolic Burden but Improved Outcomes

Analysis of 83,552 adults from 1988–2023 found crude HF prevalence increased from 2.1% to 3.0%, reaching 7.4 million adults. Age-standardized HF prevalence stayed stable, indicating population aging largely drove the higher case numbers. Among HF patients, obesity, impaired glucose homeostasis, diabetes, and CKD became more common, whereas elevated BP, hypercholesterolemia, and prior MI declined. Cardiovascular and all-cause mortality, self-reported health, and physical function improved, though noncardiovascular deaths partly counterbalanced all-cause mortality gains. 2

Second-Generation DES Failure Remains Elevated in Diabetes, Highest in Type 1

SWEDEHEART data included 160,523 patients receiving second-generation DES, with 2,406 type 1 diabetes, 43,377 type 2 diabetes, and 114,740 without diabetes. Over 4.5 years’ mean follow-up, 5,510 stent failure events occurred, defined as in-stent restenosis or stent thrombosis. Adjusted hazard ratios for stent failure versus nondiabetics were 2.28 for type 1 diabetes and 1.35 for type 2 diabetes. Both restenosis and thrombosis contributed, underscoring that DES-era PCI in diabetes—especially type 1—needs meticulous technique and vigilant long-term surveillance. 3

Semaglutide Benefits Obesity-Related HFpEF Across the Age Spectrum

This prespecified pooled STEP-HFpEF analysis randomized 1,145 obesity-related HFpEF patients to semaglutide 2.4 mg weekly or placebo for 52 weeks. Participants were distributed across <55, 55–64, 65–74, and ≥75 years, with substantial representation of older adults. Semaglutide improved KCCQ-CSS and reduced body weight consistently across all age groups, without significant age–treatment interaction. Secondary endpoints, including 6-minute walk distance and a hierarchical clinical–functional composite, also favored semaglutide with no heterogeneity by age and similar safety. 4