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Grand RoundsWeekly Evidence Brief

Internal Medicine

Edition

30-Second Takeaway

  • Routine β-blocker use after MI with preserved EF is being questioned by randomized evidence synthesis.
  • COVID-19 remains a major US cause of illness and death, especially in older adults, despite declining incidence.
  • Patients with chronic conditions disproportionately face out-of-pocket charges for ACA-covered preventive services.
  • Extended anticoagulation and optimized respiratory vaccination strategies meaningfully reduce serious outcomes in high-risk adults.
  • Communication and access gaps—including hearing loss and COVID treatment disparities—are shaping preventable hospitalizations and deaths.

Week ending January 10, 2026

New evidence reshaping routine decisions in post-MI care, respiratory vaccination, anticoagulation, prevention financing, COVID management, and multimorbidity

Meta-analysis questions routine β-blocker use after MI with preserved EF

JAMA CARDIOLOGYJan 7, 2026

This meta-analysis pooled 4 randomized trials of β-blockers after myocardial infarction in patients with preserved left ventricular ejection fraction. The study evaluated whether chronic β-blocker therapy improved cardiovascular outcomes in this lower-risk post-MI population. Findings clarify that benefits are less certain when EF is preserved, challenging automatic long-term β-blocker prescribing in all post-MI patients. Internists should individualize β-blocker continuation based on symptoms, arrhythmia risk, and competing comorbidities rather than reflex post-MI use with normal EF.

COVID-19 still caused tens of millions of US illnesses and ~100,000 deaths annually through 2024

JAMA INTERNAL MEDICINEJan 6, 2026

Using COVID-NET hospitalization data and hierarchical Bayesian modeling, this study estimated national COVID-19 burden from October 2022 to September 2024. In 2022–2023, the US had about 44 million COVID-19-associated illnesses and over 100,000 deaths. In 2023–2024, illnesses and outpatient visits declined, but hospitalizations still approached 900,000 and deaths again were about 100,000. Adults ≥65 years represented 17.7% of the population but nearly half of COVID-19 illnesses, highlighting persistent age-skewed risk. These data support continued emphasis on vaccination, early outpatient treatment, and risk counseling, especially in older adults.

Chronic conditions linked to higher out-of-pocket costs for preventive services despite ACA protections

JAMA NETWORK OPENJan 8, 2026

This cohort study analyzed >1.26 million insured patients receiving over 5.2 million preventive services from 2017 to 2020. Patients with ambulatory care–sensitive conditions had a higher likelihood of cost-sharing for preventive care than those without chronic conditions (17.91% vs 15.64%). Propensity-matched analyses showed a roughly 19% relative increase in facing any preventive out-of-pocket costs for patients with chronic conditions. These patients also had higher expected preventive out-of-pocket spending overall, partly related to coding and visit-complexity issues. Results suggest clinicians should anticipate and try to minimize inappropriate billing triggers when ordering preventive services for multimorbid patients.

References

Numbered in order of appearance. Click any reference to view details.

Additional Reads

Optional additional studies from this edition.

Edition context

Clinical signal

  • Several common inpatient and outpatient decisions—β-blocker continuation post-MI, anticoagulation duration, and discharge vaccinations—have new randomized or large-observational data refining their risk–benefit balance.
  • COVID-19 burden remains substantial, concentrated in older adults, underscoring the need for targeted vaccination, treatment access, and risk communication in primary care.
  • Implementation gaps around the ACA preventive-service mandate are financially penalizing patients with chronic disease exactly where prevention is most valuable.