Joshua Marr, MD, MPH

Background: Previous studies have shown that lower muscle function is associated with increased mortality; however, studies have not been able to fully examine associations with age and disease-specific mortality.

Study design: Prospective, population-based study.

Setting: Large population cohort in the United Kingdom (UK Biobank).

Synopsis: The UK Biobank population included 502,293 individuals, aged 40-69 years, recruited during April 2007–December 2010, with grip strength data available. Mean follow-up was 7.1 years for all-cause and disease-specific mortality. Cox proportional hazard models were used to report hazard ratios (HR) per 5-kg decrease in grip strength and were controlled for multiple sociodemographic and lifestyle factors. A lower grip strength was found to correlate with all-cause mortality (HR, 1.16 in women; HR, 1.20 in men) as well as incidence of and mortality from cardiovascular disease, respiratory disease, and cancer. Hazard ratios were higher among younger age groups with similar lower grip strength. The use of grip strength also improved the prediction of an office-based mortality risk score from cardiovascular disease.

Bottom line: Grip strength is a useful and easy-to-obtain measurement that is associated with all-cause and disease-specific morbidity and can be used to improve the prediction of an office-based risk score.

Citation: Celis-Morales CA et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all-cause mortality: Prospective cohort study of half a million UK Biobank participants. BMJ. 2018;361:k1651.

Dr. Marr is assistant professor of medicine and an academic hospitalist, University of Utah, Salt Lake City.

Background: Previous studies have shown that lower muscle function is associated with increased mortality; however, studies have not been able to fully examine associations with age and disease-specific mortality.

Study design: Prospective, population-based study.

Setting: Large population cohort in the United Kingdom (UK Biobank).

Synopsis: The UK Biobank population included 502,293 individuals, aged 40-69 years, recruited during April 2007–December 2010, with grip strength data available. Mean follow-up was 7.1 years for all-cause and disease-specific mortality. Cox proportional hazard models were used to report hazard ratios (HR) per 5-kg decrease in grip strength and were controlled for multiple sociodemographic and lifestyle factors. A lower grip strength was found to correlate with all-cause mortality (HR, 1.16 in women; HR, 1.20 in men) as well as incidence of and mortality from cardiovascular disease, respiratory disease, and cancer. Hazard ratios were higher among younger age groups with similar lower grip strength. The use of grip strength also improved the prediction of an office-based mortality risk score from cardiovascular disease.

Bottom line: Grip strength is a useful and easy-to-obtain measurement that is associated with all-cause and disease-specific morbidity and can be used to improve the prediction of an office-based risk score.

Citation: Celis-Morales CA et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all-cause mortality: Prospective cohort study of half a million UK Biobank participants. BMJ. 2018;361:k1651.

Dr. Marr is assistant professor of medicine and an academic hospitalist, University of Utah, Salt Lake City.

Background: Previous studies have shown that lower muscle function is associated with increased mortality; however, studies have not been able to fully examine associations with age and disease-specific mortality.

Study design: Prospective, population-based study.

Setting: Large population cohort in the United Kingdom (UK Biobank).

Synopsis: The UK Biobank population included 502,293 individuals, aged 40-69 years, recruited during April 2007–December 2010, with grip strength data available. Mean follow-up was 7.1 years for all-cause and disease-specific mortality. Cox proportional hazard models were used to report hazard ratios (HR) per 5-kg decrease in grip strength and were controlled for multiple sociodemographic and lifestyle factors. A lower grip strength was found to correlate with all-cause mortality (HR, 1.16 in women; HR, 1.20 in men) as well as incidence of and mortality from cardiovascular disease, respiratory disease, and cancer. Hazard ratios were higher among younger age groups with similar lower grip strength. The use of grip strength also improved the prediction of an office-based mortality risk score from cardiovascular disease.

Bottom line: Grip strength is a useful and easy-to-obtain measurement that is associated with all-cause and disease-specific morbidity and can be used to improve the prediction of an office-based risk score.

Citation: Celis-Morales CA et al. Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all-cause mortality: Prospective cohort study of half a million UK Biobank participants. BMJ. 2018;361:k1651.

Dr. Marr is assistant professor of medicine and an academic hospitalist, University of Utah, Salt Lake City.

Background: Per Chest guidelines, VTE prophylaxis is recommended for hospitalized patients at increased risk for VTE but is not recommended for low-risk patients. Risk stratification can be guided by the Padua Prediction Score to categorize patients.

Study design: Multicenter observational study.

Setting: A total of 52 U.S. hospitals (Michigan Hospital Medicine Safety Consortium database).

Synopsis: Patients admitted during Jan. 1, 2015–Dec. 21, 2016, to 52 non–intensive care medical units for 2 or more days were analyzed and stratified as high or low risk for VTE using the Padua Prediction Score. Excessive VTE prophylaxis was defined as low-risk patients prescribed pharmacologic or mechanical prophylaxis, high-risk patients receiving therapy despite a contraindication to prophylaxis, or any patient who received both mechanical and pharmacologic therapy. Underuse of VTE prophylaxis included high-risk patients who did not receive pharmacologic or mechanical prophylaxis. Of the 44,775 patients included in the study, 32,549 were low risk, and 77.9% (25,369 patients) received excessive VTE prophylaxis. Overtreatment also was present in high-risk patients with and without a contraindication to VTE prophylaxis (26.9% and 32.3%, respectively). Underuse of VTE prophylaxis occurred in 2,693 high-risk patients (22%).

Bottom line: Patients who are at low risk for VTE by Padua Prediction Score often are prescribed pharmacologic or mechanical prophylaxis that may be unnecessary. Overuse of VTE prophylaxis was more common than is underuse.

Citation: Grant PJ et al. Use of venous thromboembolism prophylaxis in hospitalized patients. JAMA Intern Med. 2018 Aug 1;178(8):1122-4. Published online May 21, 2018.

Dr. Marr is assistant professor of medicine and an academic hospitalist, University of Utah, Salt Lake City.

Background: Per Chest guidelines, VTE prophylaxis is recommended for hospitalized patients at increased risk for VTE but is not recommended for low-risk patients. Risk stratification can be guided by the Padua Prediction Score to categorize patients.

Study design: Multicenter observational study.

Setting: A total of 52 U.S. hospitals (Michigan Hospital Medicine Safety Consortium database).

Synopsis: Patients admitted during Jan. 1, 2015–Dec. 21, 2016, to 52 non–intensive care medical units for 2 or more days were analyzed and stratified as high or low risk for VTE using the Padua Prediction Score. Excessive VTE prophylaxis was defined as low-risk patients prescribed pharmacologic or mechanical prophylaxis, high-risk patients receiving therapy despite a contraindication to prophylaxis, or any patient who received both mechanical and pharmacologic therapy. Underuse of VTE prophylaxis included high-risk patients who did not receive pharmacologic or mechanical prophylaxis. Of the 44,775 patients included in the study, 32,549 were low risk, and 77.9% (25,369 patients) received excessive VTE prophylaxis. Overtreatment also was present in high-risk patients with and without a contraindication to VTE prophylaxis (26.9% and 32.3%, respectively). Underuse of VTE prophylaxis occurred in 2,693 high-risk patients (22%).

Bottom line: Patients who are at low risk for VTE by Padua Prediction Score often are prescribed pharmacologic or mechanical prophylaxis that may be unnecessary. Overuse of VTE prophylaxis was more common than is underuse.

Citation: Grant PJ et al. Use of venous thromboembolism prophylaxis in hospitalized patients. JAMA Intern Med. 2018 Aug 1;178(8):1122-4. Published online May 21, 2018.

Dr. Marr is assistant professor of medicine and an academic hospitalist, University of Utah, Salt Lake City.

Background: Per Chest guidelines, VTE prophylaxis is recommended for hospitalized patients at increased risk for VTE but is not recommended for low-risk patients. Risk stratification can be guided by the Padua Prediction Score to categorize patients.

Study design: Multicenter observational study.

Setting: A total of 52 U.S. hospitals (Michigan Hospital Medicine Safety Consortium database).

Synopsis: Patients admitted during Jan. 1, 2015–Dec. 21, 2016, to 52 non–intensive care medical units for 2 or more days were analyzed and stratified as high or low risk for VTE using the Padua Prediction Score. Excessive VTE prophylaxis was defined as low-risk patients prescribed pharmacologic or mechanical prophylaxis, high-risk patients receiving therapy despite a contraindication to prophylaxis, or any patient who received both mechanical and pharmacologic therapy. Underuse of VTE prophylaxis included high-risk patients who did not receive pharmacologic or mechanical prophylaxis. Of the 44,775 patients included in the study, 32,549 were low risk, and 77.9% (25,369 patients) received excessive VTE prophylaxis. Overtreatment also was present in high-risk patients with and without a contraindication to VTE prophylaxis (26.9% and 32.3%, respectively). Underuse of VTE prophylaxis occurred in 2,693 high-risk patients (22%).

Bottom line: Patients who are at low risk for VTE by Padua Prediction Score often are prescribed pharmacologic or mechanical prophylaxis that may be unnecessary. Overuse of VTE prophylaxis was more common than is underuse.

Citation: Grant PJ et al. Use of venous thromboembolism prophylaxis in hospitalized patients. JAMA Intern Med. 2018 Aug 1;178(8):1122-4. Published online May 21, 2018.

Dr. Marr is assistant professor of medicine and an academic hospitalist, University of Utah, Salt Lake City.