Study reveals how sex impacts heart attack survival

A study of 900,000-plus patients found frail men faced a higher one-year death risk after a heart attack, although severe frailty was more common in women.

While attention has rightly focused on women often being undertreated after a heart attack, the research points to what it describes as a hidden and serious vulnerability in men.

The study found severe frailty, a state where the body’s reserves are reduced and recovery is harder, was more common in women after a heart attack, but the one-year risk of death was significantly higher for frail men.

This creates a more complex picture, with women facing inequalities in access to care, while frail men face what the researchers describe as a “malignant” prognosis that current standard treatments are failing to address.

The research, which the authors describe as the largest of its kind, was led by the University of Leicester and funded by the National Institute for Health and Care Research and British Heart Foundation Centre of Excellence. It analysed national data over a 15-year period to disentangle the relationship between sex, frailty and survival. It was conducted through an international collaboration with the Victor Phillip Dahdaleh Heart and Lung Research Institute at the University of Cambridge and the Center for Geriatric Medicine at the Cleveland Clinic.

Dr Muhammad Rashid, from the University of Leicester’s department of cardiovascular sciences and senior clinical research fellow for the NIHR Leicester Biomedical Research Centre, led the study alongside Dr Hasan Mohiaddin and Horatio Mosanya.

He said: “The study challenges current risk assessments which often treat frailty as a uniform predictor.”

Rashid said the interaction between frailty and sex had not previously been explored, leaving a gap in understanding patient risk. He said the findings relate to AMI patients, with AMI meaning acute myocardial infarction, the medical term for a heart attack.

“Our study provides new insights into this, demonstrating that the likely impact of frailty in AMI patients is not uniform, but significantly modified by sex. In males this could be rooted in fundamental differences with data suggesting they are more prone to artery blockages and have a higher prevalence of diabetes and multiple diseases, and a more vulnerable cardiac state. Even when they receive more intensive therapeutic care, their vulnerability and diminished physiological reserves to withstand another major cardiovascular event are low.”

“However, frailty in females may represent a more multi-system decline not exclusively linked to the severity of their coronary disease. This suggests that frailty in females is a marker of accumulated disability across multiple systems rather than being driven primarily by advanced coronary disease.”

Rashid said the findings could have significant clinical implications. He added that current risk assessment needs to evolve so that male care pathways after a heart attack are enhanced beyond cardio-metabolic management and prioritised cardiac rehabilitation, while equitable delivery of established, life-saving therapies should be established for females.

“The development and validation of new sex-specific frailty assessment tools should therefore be a priority for future research as such tools may be better suited to identifying high-risk individuals and guiding targeted interventions for the most vulnerable patients.”