More Than 1 in 6 People With ACS Are at Intermediate or High Risk for Frailty

Background: Frailty is a common comorbidity among the general population, particularly those with acute coronary syndrome (ACS). Frail patients with ACS are under-represented in cardiology trials, and whether usual acute care therapies including revascularization have the same benefits in frail patients is unknown. Objective: To determine the association of revascularization with outcome among frail patients with ACS using causal inference techniques. Design: Longitudinal observational study. Methods: A national health database in England was used for this analysis. Patients with ST-elevation myocardial infarction, non–ST-elevation myocardial infarction, or unstable angina between 2010 and 2015 were included. Frailty was identified using the Hospital Frailty Risk Score and classified as low, intermediate, or high risk. Revascularization was identified as the exposure of interest, and cardiovascular mortality was the primary outcome. An instrumental variable analysis was used to more...