Landmark study reveals hidden frailty crisis in young heart attack patients

Researchers have uncovered a major blind spot in the way doctors assess future health risk in young adults who suffer a heart attack.

Published today in the European Heart Journal the study, led by the University of Leicester, shows that frailty - traditionally viewed as a condition of old age - is both common and deadly in people under 55.

By analysing nearly one million heart attack cases across England and Wales, the team found that young adults living with severe frailty face a dramatically higher risk of premature death - yet they often receive less frailty screening and fewer specialised support services than older patients.

For decades, frailty has been defined by slow walking speed, weakness, and classic geriatric symptoms. As a result, younger adults are rarely assessed for it with clinicians often assuming that a 45-year-old patient is "too young to be frail."

However, this latest study overturns that belief. 

Researchers identified a distinct type of frailty in younger people, driven by a cluster of cardiovascular and metabolic illnesses-such as diabetes, hypertension, kidney disease, and early-onset heart failure-that accumulate far earlier than expected.

Because this biological vulnerability goes unrecognised, these patients frequently miss out on the intensive treatment and follow-up care they urgently need.

Led by Dr Hasan Mohiaddin and Dr Muhammad Rashid from the Department of Cardiovascular Sciences, the study reports:

• Frailty is common: Nearly 1 in 10 heart attack patients under 55 years were classified as moderately or severely frail.

• Frailty in the young is different: Unlike age-related frailty seen in older adults, young frail patients show a unique pattern dominated by cardiovascular and metabolic illnesses, rather than mobility or memory issues.

• In young adults, the impact of severe frailty is even more pronounced. Relative to older adults, young patients with severe frailty had a nearly four-fold higher risk of death compared with fit people the same age.

Dr Hasan Mohiaddin, first author of the study, said: "In practice, we are seeing more young patients with multiple health conditions who don't fit the traditional image of frailty, yet they still experience poor outcomes. 

“Our data shows these patients are biologically vulnerable in ways that age alone cannot explain. We can no longer assume that a 45-year-old will simply bounce back after a heart attack."

The research represents a major international collaboration led by Leicester, involving experts from Keele University, University of Leeds, Uppsala University (Sweden), and Centre of Aging, Cleveland Clinic (USA), and Baylor Scott & White Research Institution (USA).

The study will now form the foundation of a new, multi-year research programme at Leicester led by Dr Rashid which aims to redefine how doctors assess risk, look at the development of personalised treatments, and the introduction of new guidelines for patient frailty assessments. 

Dr Muhammad Rashid, an Interventional Cardiologist, said: “It’s my belief that frailty assessments should be used routinely in all heart attack patients, not just older adults.

"This study has uncovered a hidden high-risk population that current assessment models fail to protect - a young patient with this specific cardiovascular frailty profile has a far lower survival rate than many older adults.

“At Leicester, we are launching a dedicated programme to identify these patients earlier and develop targeted treatments that can halt this trajectory and save years of life."