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IMPORTANCE As coronavirus disease 2019 (COVID-19) spread throughout the US in the early months of 2020, acute care delivery changed to accommodate an influx of patients with a highly contagious infection about which little was known. OBJECTIVE To examine trends in emergency department (ED) visits and visits that led to hospitalizations covering a 4-month period leading up to and during the COVID-19 outbreak in the US. DESIGN, SETTING, AND PARTICIPANTS This retrospective, observational, cross-sectional study of 24 EDs in 5 large health care systems in Colorado (n = 4), Connecticut (n = 5), Massachusetts (n = 5), New York (n = 5), and North Carolina (n = 5) examined daily ED visit and hospital admission rates from January 1 to April 30, 2020, in relation to national and the 5 states' COVID-19 case counts. EXPOSURES Time (day) as a continuous variable. MAIN OUTCOMES AND MEASURES Daily counts of ED visits, hospital admissions, and COVID-19 cases. RESULTS A total of 24 EDs were studied. The annual ED volume before the COVID-19 pandemic ranged from 13 000 to 115 000 visits per year; the decrease in ED visits ranged from 41.5% in Colorado to 63.5% in New York. The weeks with the most rapid rates of decrease in visits were in March 2020, which corresponded with national public health messaging about COVID-19. Hospital admission rates from the ED were stable until new COVID-19 case rates began to increase locally; the largest relative increase in admission rates was 149.0% in New York, followed by 51.7% in Massachusetts, 36.2% in Connecticut, 29.4% in Colorado, and 22.0% in North Carolina. CONCLUSIONS AND RELEVANCE From January through April 2020, as the COVID-19 pandemic intensified in the US, temporal associations were observed with a decrease in ED visits and an increase in hospital admission rates in 5 health care systems in 5 states. These findings suggest that practitioners and public health officials should emphasize the importance of visiting the ED during the COVID-19 pandemic for serious symptoms, illnesses, and injuries that cannot be managed in other settings.

Background Various national campaigns launched in recent years focused on young women with acute myocardial infarction (AMI). Contemporary longitudinal data about sex differences in clinical characteristics, hospitalization rates, length of stay (LOS), and mortality have not been examined. Objective To determine sex differences in clinical characteristics, hospitalization rates, LOS, and in-hospital mortality by age groups and race among young patients with AMI using a large national dataset of U.S. hospital discharges. Methods Using the National Inpatient Sample (NIS), we compared clinical characteristics, AMI hospitalization rates, LOS, and in-hospital mortality for patients with AMI across ages 30–54 years, dividing them into 5-year subgroups from 2001–2010, using survey data analysis techniques. Results We identified 230,684 hospitalizations with a principal discharge diagnosis of AMI in 30–54-year-old patients from NIS data, representing an estimated 1,129,949 hospitalizations in the U.S. from 2001–2010. No statistically significant declines in AMI hospitalization rates were observed in the age groups <55 years, or stratified by sex. Prevalence of comorbidities was higher in women and increased among both sexes through the study period. Women had longer LOS and higher in-hospital mortality than men across all age groups. However, observed inhospital mortality declined significantly for women from 2001 to 2010 (3.3% to 2.3%, relative change 30.5%, p-for-trend<0.0001); but not for men (2.0% to 1.8%, relative change 8.6%, p-for-trend=0.6). Conclusions AMI hospitalization rates for young people have not declined over the past decade. Young women with AMI have more comorbidity, longer LOS, and higher in-hospital mortality than young men.

BackgroundWe compared the clinical characteristics and outcomes of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) versus obstructive disease (myocardial infarction due to coronary artery disease [MI‐CAD]) and among patients with MINOCA by sex and subtype.Methods and ResultsBetween 2008 and 2012, VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) prospectively enrolled acute myocardial infarction patients aged 18 to 55 years in 103 hospitals at a 2:1 ratio of women to men. Using an angiographically driven taxonomy, we defined patients as having MI‐CAD if there was revascularization or plaque ≥50% and as having MINOCA if there was <50% obstruction or a nonplaque mechanism. Patients who did not have an angiogram or who received thrombolytics before an angiogram were excluded. Outcomes included 1‐ and 12‐month mortality and functional (Seattle Angina Questionnaire [SAQ]) and psychosocial status. Of 2690 patients undergoing angiography, 2374 (88.4%) had MI‐CAD, 299 (11.1%) had MINOCA, and 17 (0.6%) remained unclassified. Women had 5 times higher odds of having MINOCA than men (14.9% versus 3.5%; odds ratio: 4.84; 95% confidence interval, 3.29–7.13). MINOCA patients were more likely to be without traditional cardiac risk factors (8.7% versus 1.3%; P<0.001) but more predisposed to hypercoaguable states than MI‐CAD patients (3.0% versus 1.3%; P=0.036). Women with MI‐CAD were more likely than those with MINOCA to be menopausal (55.2% versus 41.2%; P<0.001) or to have a history of gestational diabetes mellitus (16.8% versus 11.0%; P=0.028). The MINOCA mechanisms varied: a nonplaque mechanism was identified for 75 patients (25.1%), and their clinical profiles and management also varied. One‐ and 12‐month mortality with MINOCA and MI‐CAD was similar (1‐month: 1.1% and 1.7% [P=0.43]; 12‐month: 0.6% and 2.3% [P=0.68], respectively), as was adjusted 12‐month SAQ quality of life (76.5 versus 73.5, respectively; P=0.06).ConclusionsYoung patients with MINOCA were more likely women, had a heterogeneous mechanistic profile, and had clinical outcomes that were comparable to those of MI‐CAD patients.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597922.

BACKGROUND Brief interventions (BI) have been shown to reduce alcohol use and improve outcomes in Hazardous and Harmful (HH) drinkers but evidence to support their use in emergency department (ED) patients is limited. The use of research assessments in studies of BI may contribute to uncertainty about their effectiveness. METHODS We randomized 889 adult ED patients with HH drinking. A total of 740 received 1) an emergency practitioner (EP)-performed Brief Negotiation Interview (BNI, n=297), 2) BNI with a 1-month follow-up telephone booster (BNI with Booster), (n=295), or 3) standard care (SC, n=148). We also included a standard care with no assessments (SC-NA, n=149) group to examine the impact of assessments on drinking outcomes. Primary outcomes analyzed using mixed models procedures included past 7-day alcohol consumption and 28-day binge episodes at 6 and 12 months collected by Interactive Voice Response. Secondary outcomes included negative health behaviors and consequences collected by phone surveys. RESULTS The reduction in mean number of drinks in the past 7 days from baseline to 6 and 12 months was significantly greater in BNI with Booster: from 20.4 (95% confidence interval [CI], 18.8-22.0) to 11.6 (95% CI, 9.7-13.5) to 13.0 (95% CI, 10.5-15.5) and BNI: from 19.8 (95% CI, 18.3-21.4) to 12.7 (95% CI, 10.8-14.6), to 14.3 (95% CI, 11.9-16.8), than in SC: from 20.9 (95% CI, 18.7-23.2) to 14.2 (95% CI, 11.2-17.1), to 17.6 (95% CI, 14.1-21.2). The reduction in 28-day binge episodes was also greater in BNI with Booster: from 7.5 (95% CI, 6.8-8.2) to 4.4 (95% CI, 3.6-5.2) to 4.7 (95% CI, 3.9-5.6) and in BNI: from 7.2 (95% CI, 6.5-7.9) to 4.8 (95% CI, 4.0-5.6), to 5.1 (95% CI, 4.2-5.9), than in SC: from 7.2 (95% CI, 6.2-8.2) to 5.7 (95% CI, 4.5-6.9), to 5.8 (95% CI, 4.6-7.0). BNI with Booster offered no significant benefit over BNI. There were no differences in drinking outcomes between the SC and SC-NA groups. The reductions in rates of driving after drinking ≥ 3 drinks from baseline to 12 months were greater in the BNI (38% to 29%) and BNI with Booster (39% to 31%) groups than in the SC group (43% to 42%). CONCLUSIONS EP-performed brief interventions can reduce alcohol consumption and episodes of driving after drinking in HH drinkers. These results support the use of brief interventions in ED settings.

Whole-genome sequencing to characterize monogenic and polygenic contributions in patients hospitalized with early-onset myocardial infarction The MIT Faculty has made this article openly available. Please share how this access benefits you. Your story matters. Citation Khera, Amit V., et al., "Whole-genome sequencing to characterize monogenic and polygenic contributions in patients hospitalized with early-onset myocardial infarction."

IMPORTANCE Treatment of opioid use disorder (OUD) with buprenorphine decreases opioid use and prevents morbidity and mortality. Emergency departments (EDs) are an important setting for buprenorphine initiation for patients with untreated OUD; however, readiness varies among ED clinicians. OBJECTIVE To characterize barriers and facilitators of readiness to initiate buprenorphine for the treatment of OUD in the ED and identify opportunities to promote readiness across multiple clinician types.

Study Objective-To determine efficacy of emergency practitioner performed brief intervention for hazardous/harmful drinkers in reducing alcohol consumption and negative consequences in an Emergency Department (ED) setting.Methods-A randomized clinical trial (Project ED Health) was conducted in an urban ED from 5/2002 to 11/2003 for hazardous/harmful drinkers. Patients ≥ 18 who screened above National Institute for Alcohol Abuse and Alcoholism guidelines for "low risk" drinking or presented with an injury in the setting of alcohol ingestion were eligible. The mean number of drinks per week and binge drinking episodes over the past 30 days were collected at 6 and 12-months; negative consequences and use of treatment services at 12-months. A Brief Negotiation Interview (BNI) performed by emergency practitioners was compared to scripted discharge instructions (DI).Results-A total of 494 hazardous/harmful drinkers were studied. The two groups were similar with respect to baseline characteristics. In the BNI group the mean number of drinks per week at 12 months was 3.8 less than the 13.6 reported at baseline. The DI group decreased 2.6 from 12.4 at baseline. Likewise, binge drinking episodes per month decreased by 2.0 from a baseline of 6.0 in the BNI group and 1.5 from 5.4 in the DI group. For each outcome the time effect was significant and the treatment effect was not. Conclusion: Among ED patients with hazardous/harmful drinking, we did not detect a difference in efficacy between emergency practitioner-performed BNI and DI. Further studies to test the efficacy of brief intervention in the ED are needed.