John Gerstenberger, MD

Background: The ability to independently perform daily activities is highly valued by patients, yet it is commonly impaired in older adults after hospitalization for MI. Risk of functional decline in this population is not well understood, but may relate to reduced mobility while hospitalized.

Study design: Prospective cohort.

Setting: A total of 94 academic and community hospitals in the United States.

Synopsis: More than 3,000 adults aged 75 years and older who were hospitalized for acute myocardial infarction were enrolled in the prospective cohort SILVER-AMI; 2,587 patients within this cohort were evaluated for in-hospital mobility with the Timed “Up and Go” test. At 6-month follow-up, loss of independent performance of activities of daily living (ADL) and of the ability to walk 0.25 miles were both associated in a dose-dependent manner with in-hospital mobility. Severe in-hospital mobility impairment was associated with ADL decline with an adjusted odds ratio of 5.45 (95% confidence interval, 3.29-9.01).

While in-hospital mobility is predictive of future functional decline in this population, this observational study cannot establish whether attempts to improve mobility in hospitalized patients will prevent future functional decline.

Bottom line: Lower performance on the Timed “Up and Go” test of mobility among older patients hospitalized for MI is associated with functional decline 6 months after hospitalization.

Citation: Hajduk AM et al. Association between mobility measured during hospitalization and functional outcomes in older adults with acute myocardial infarction in the SILVER-AMI study. JAMA Intern Med. 2019 Oct 7. doi: 10.1001/jamainternmed.2019.4114.

Dr. Gerstenberger is a hospitalist and clinical assistant professor of medicine at the University of Utah, Salt Lake City.

Background: The ability to independently perform daily activities is highly valued by patients, yet it is commonly impaired in older adults after hospitalization for MI. Risk of functional decline in this population is not well understood, but may relate to reduced mobility while hospitalized.

Study design: Prospective cohort.

Setting: A total of 94 academic and community hospitals in the United States.

Synopsis: More than 3,000 adults aged 75 years and older who were hospitalized for acute myocardial infarction were enrolled in the prospective cohort SILVER-AMI; 2,587 patients within this cohort were evaluated for in-hospital mobility with the Timed “Up and Go” test. At 6-month follow-up, loss of independent performance of activities of daily living (ADL) and of the ability to walk 0.25 miles were both associated in a dose-dependent manner with in-hospital mobility. Severe in-hospital mobility impairment was associated with ADL decline with an adjusted odds ratio of 5.45 (95% confidence interval, 3.29-9.01).

While in-hospital mobility is predictive of future functional decline in this population, this observational study cannot establish whether attempts to improve mobility in hospitalized patients will prevent future functional decline.

Bottom line: Lower performance on the Timed “Up and Go” test of mobility among older patients hospitalized for MI is associated with functional decline 6 months after hospitalization.

Citation: Hajduk AM et al. Association between mobility measured during hospitalization and functional outcomes in older adults with acute myocardial infarction in the SILVER-AMI study. JAMA Intern Med. 2019 Oct 7. doi: 10.1001/jamainternmed.2019.4114.

Dr. Gerstenberger is a hospitalist and clinical assistant professor of medicine at the University of Utah, Salt Lake City.

Background: The ability to independently perform daily activities is highly valued by patients, yet it is commonly impaired in older adults after hospitalization for MI. Risk of functional decline in this population is not well understood, but may relate to reduced mobility while hospitalized.

Study design: Prospective cohort.

Setting: A total of 94 academic and community hospitals in the United States.

Synopsis: More than 3,000 adults aged 75 years and older who were hospitalized for acute myocardial infarction were enrolled in the prospective cohort SILVER-AMI; 2,587 patients within this cohort were evaluated for in-hospital mobility with the Timed “Up and Go” test. At 6-month follow-up, loss of independent performance of activities of daily living (ADL) and of the ability to walk 0.25 miles were both associated in a dose-dependent manner with in-hospital mobility. Severe in-hospital mobility impairment was associated with ADL decline with an adjusted odds ratio of 5.45 (95% confidence interval, 3.29-9.01).

While in-hospital mobility is predictive of future functional decline in this population, this observational study cannot establish whether attempts to improve mobility in hospitalized patients will prevent future functional decline.

Bottom line: Lower performance on the Timed “Up and Go” test of mobility among older patients hospitalized for MI is associated with functional decline 6 months after hospitalization.

Citation: Hajduk AM et al. Association between mobility measured during hospitalization and functional outcomes in older adults with acute myocardial infarction in the SILVER-AMI study. JAMA Intern Med. 2019 Oct 7. doi: 10.1001/jamainternmed.2019.4114.

Dr. Gerstenberger is a hospitalist and clinical assistant professor of medicine at the University of Utah, Salt Lake City.

Background: Beta-blockers are underutilized in patients with both COPD and established cardiovascular indications for beta-blocker therapy, despite evidence suggesting overall benefit. Prior observational studies have associated beta-blockers with improved outcomes in COPD in the absence of cardiovascular indications; however, this has not been previously evaluated in a randomized trial.

Study design: Placebo-controlled, double-blind, prospective, randomized trial.

Setting: A total of 26 centers in the United States.

Synopsis: The BLOCK COPD trial randomized more than 500 patients with moderate to severe COPD and no established indication for beta-blocker therapy to extended-release metoprolol or placebo. There was no significant difference in the primary endpoint of time until first exacerbation. While there was no difference in the overall risk of exacerbations of COPD, the trial was terminated early because of increased risk of severe or very severe exacerbations of COPD in the metoprolol group (hazard ratio, 1.91; 95% confidence interval, 1.20-2.83). These were defined as exacerbations requiring hospitalization and mechanical ventilation, respectively.

Importantly, this trial excluded patients with established indications for beta-blocker therapy, and study findings should not be applied to this population.

Bottom line: Metoprolol is not associated with increased risk of COPD exacerbations, but is associated with increased severity of COPD exacerbations in patients with moderate to severe COPD who have no established indications for beta-blockers.

Citation: Dransfield MT et al. Metoprolol for the prevention of acute exacerbations of COPD. N Engl J Med. 2019 Oct 20. doi: 10.1056/NEJMoa1908142.

Dr. Gerstenberger is a hospitalist and clinical assistant professor of medicine at the University of Utah, Salt Lake City.

Background: Beta-blockers are underutilized in patients with both COPD and established cardiovascular indications for beta-blocker therapy, despite evidence suggesting overall benefit. Prior observational studies have associated beta-blockers with improved outcomes in COPD in the absence of cardiovascular indications; however, this has not been previously evaluated in a randomized trial.

Study design: Placebo-controlled, double-blind, prospective, randomized trial.

Setting: A total of 26 centers in the United States.

Synopsis: The BLOCK COPD trial randomized more than 500 patients with moderate to severe COPD and no established indication for beta-blocker therapy to extended-release metoprolol or placebo. There was no significant difference in the primary endpoint of time until first exacerbation. While there was no difference in the overall risk of exacerbations of COPD, the trial was terminated early because of increased risk of severe or very severe exacerbations of COPD in the metoprolol group (hazard ratio, 1.91; 95% confidence interval, 1.20-2.83). These were defined as exacerbations requiring hospitalization and mechanical ventilation, respectively.

Importantly, this trial excluded patients with established indications for beta-blocker therapy, and study findings should not be applied to this population.

Bottom line: Metoprolol is not associated with increased risk of COPD exacerbations, but is associated with increased severity of COPD exacerbations in patients with moderate to severe COPD who have no established indications for beta-blockers.

Citation: Dransfield MT et al. Metoprolol for the prevention of acute exacerbations of COPD. N Engl J Med. 2019 Oct 20. doi: 10.1056/NEJMoa1908142.

Dr. Gerstenberger is a hospitalist and clinical assistant professor of medicine at the University of Utah, Salt Lake City.

Background: Beta-blockers are underutilized in patients with both COPD and established cardiovascular indications for beta-blocker therapy, despite evidence suggesting overall benefit. Prior observational studies have associated beta-blockers with improved outcomes in COPD in the absence of cardiovascular indications; however, this has not been previously evaluated in a randomized trial.

Study design: Placebo-controlled, double-blind, prospective, randomized trial.

Setting: A total of 26 centers in the United States.

Synopsis: The BLOCK COPD trial randomized more than 500 patients with moderate to severe COPD and no established indication for beta-blocker therapy to extended-release metoprolol or placebo. There was no significant difference in the primary endpoint of time until first exacerbation. While there was no difference in the overall risk of exacerbations of COPD, the trial was terminated early because of increased risk of severe or very severe exacerbations of COPD in the metoprolol group (hazard ratio, 1.91; 95% confidence interval, 1.20-2.83). These were defined as exacerbations requiring hospitalization and mechanical ventilation, respectively.

Importantly, this trial excluded patients with established indications for beta-blocker therapy, and study findings should not be applied to this population.

Bottom line: Metoprolol is not associated with increased risk of COPD exacerbations, but is associated with increased severity of COPD exacerbations in patients with moderate to severe COPD who have no established indications for beta-blockers.

Citation: Dransfield MT et al. Metoprolol for the prevention of acute exacerbations of COPD. N Engl J Med. 2019 Oct 20. doi: 10.1056/NEJMoa1908142.

Dr. Gerstenberger is a hospitalist and clinical assistant professor of medicine at the University of Utah, Salt Lake City.