Background: Studies of patients with cardiovascular implantable electronic devices show a relationship between atrial fibrillation (AF) duration and stroke risk, although the interaction with CHA 2 DS 2 -VASc score is poorly defined. The objective of this study is to evaluate rates of stroke and systemic embolism (SSE) in patients with cardiovascular implantable electronic devices as a function of both CHA 2 DS 2 -VASc score and AF duration. Methods: Data from the Optum electronic health record deidentified database (2007–2017) were linked to the Medtronic CareLink database of cardiovascular implantable electronic devices capable of continuous AF monitoring. An index date was assigned as the later of either 6 months after device implantation or 1 year after electronic health record data availability. CHA 2 DS 2 -VASc score was assessed using electronic health record data before the index date. Maximum daily AF burden (no AF, 6 minutes–23.5 hours, and >23.5 hours) was assessed over the 6 months before the index date. SSE rates were computed after the index date. Results: Among 21 768 nonanticoagulated patients with cardiovascular implantable electronic devices (age, 68.6±12.7 years; 63% male), both increasing AF duration ( P <0.001) and increasing CHA 2 DS 2 -VASc score ( P <0.001) were significantly associated with annualized risk of SSE. SSE rates were low in patients with a CHA 2 DS 2 -VASc score of 0 to 1 regardless of device-detected AF duration. However, stroke risk crossed an actionable threshold defined as >1%/y in patients with a CHA 2 DS 2 -VASc score of 2 with >23.5 hours of AF, those with a CHA 2 DS 2 -VASc score of 3 to 4 with >6 minutes of AF, and patients with a CHA 2 DS 2 -VASc score ≥5 even with no AF. Conclusions: There is an interaction between AF duration and CHA 2 DS 2 -VASc score that can further risk-stratify patients with AF for SSE and may be useful in guiding anticoagulation therapy.

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Background Healthcare workers (HCW) treating coronavirus disease 2019 (COVID‐19) patients face high levels of psychological stress. We aimed to compare mental health outcomes, risk and protective factors for posttraumatic stress symptoms (PTSS), probable depression, and anxiety between HCW working in COVID‐19 and non‐COVID‐19 wards. Methods A self‐report survey, administered in a large tertiary hospital in Israel during the peak of the COVID‐19 outbreak was completed by 828 HCW (42.2% physicians, 57.8% nurses. Patient‐Reported Outcomes Measurement Information System; the Patient Health Questionnaire‐9; the Primary Care‐Post Traumatic Stress Disorder Screen for DSM‐5 (PC‐PTSD‐5) were used for assessing anxiety, depression, and PTSS, respectively. Pandemic‐related stress factors, negative experiences, and potential protective factors were also assessed. Results Median PC‐PTSD scores differed significantly between study teams ( χ 2 [5] = 17.24; p = .004). Prevalence of probable depression and anxiety were similar in both groups. Risk factors for mental health outcomes included mental exhaustion, anxiety about being infected and infecting family. Overall, higher proportion of the COVID‐19 team witnessed patient deaths as compared to the non‐COVID‐19 team (50.2% vs. 24.7%). Witnessing patient death at the COVID‐19 wards was associated with a four‐fold increased likelihood of PTSS (odds ratio [OR] = 3.97; 95% confidence interval [CI], 1.58–9.99; p = .0007), compared with the non‐COVID‐19 wards (OR 0.91; 95% CI, 0.51–1.61; p = .43). Conclusions Witnessing patient death appears to be a risk factor for PTSS unique to HCW directly engaged in treating patients with COVID‐19. Our findings suggest that helping HCW cope with COVID‐19 related deaths might reduce their risk of posttraumatic stress.

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