Background The COVID-19 pandemic is putting health professionals under increasing pressure. This population is already acknowledged to be at risk of burnout. Aim We aim to provide a ‘snapshot’ of the levels of burnout, anxiety, depression and distress among healthcare workers during the COVID-19 pandemic. Methods We distributed an online survey via social media in June 2020 open to any UK healthcare worker. The primary outcome measure was symptoms of burnout measured using the Copenhagen Burnout Inventory (CBI). Secondary outcomes of depression, anxiety, distress and subjective measures of stress were also recorded. Multivariate logistic regression analysis was performed to identify factors associated with burnout, depression, anxiety and distress. Results A total of 539 persons responded to the survey; 90% female, 53% nurses. Participants with moderate-to-severe burnout were younger (49% versus 33% under 40 years, P = 0.004), more likely to have pre-existing comorbidities (21% versus 12%, P = 0.031), twice as likely to have been redeployed from their usual role (22% versus 11%; P = 0.042), or to work in an area dedicated to COVID-19 patients (50% versus 32%, P < 0.001), and were almost 4 times more likely to have previous depression (24% versus 7%; P = 0.012). Conclusion Independent predictors of burnout were being younger, redeployment, exposure to patients with COVID-19, being female, and a history of depression. Evaluation of existing psychological support interventions is required with targeted approaches to ensure support is available to those most at risk.

Objective We aim to provide a snapshot of the levels of burnout, anxiety, depression and distress among healthcare workers during the COVID-19 pandemic. Design, setting, participants We distributed an online survey via social media in June 2020 that was open to any healthcare worker. The primary outcome measure was symptoms of burnout as measured using the Copenhagen Burnout Inventory (CBI). Secondary outcomes of depression, anxiety and distress as measured using the Patient Health Questionnaire-9, General Anxiety Scale-7, and Impact of Events Scale-Revised were recorded along with subjective measures of stress. Multivariate logistic regression analysis was performed to identify factors associated with burnout, depression, anxiety and distress. Results Of 539 persons responding to the survey, 90% were female, and 26% were aged 41-50 years, 53% were nurses. Participants with moderate-to-severe burnout were younger (49% [206/424] versus 33% [38/115] under 40 years, P=0.004), and more likely to have pre-existing comorbidities (21% versus 12%, P=0.031). They were twice as likely to have been redeployed from their usual role (22% versus 11%; adjusted odds ratio [OR] 2.2, 95% confidence interval [CI] 1.5-3.3, P=0.042), or to work in an area dedicated to COVID-19 patients (50% versus 32%, adjusted OR 1.6, 95% CI 1.4-1.8, P<0.001), and were almost 4-times more likely to have previous depression (24% versus 7%; adjusted OR 3.6, 95% CI 2.2-5.9, P=0.012). A supportive workplace team and male sex protected against burnout reducing the odds by 40% (adjusted OR 0.6, 95% CI 0.5-0.7, P<0.001) and 70% (adjusted OR 0.3, 95% CI 0.2-0.5, P=0.003), respectively. Conclusion Independent predictors of burnout were younger staff, redeployment to a new working area, working with patients with confirmed COVID-19 infection, and being female or having a previous history of depression. Evaluation of existing psychological support interventions is required with targeted approaches to ensure support is available to those most at risk.

Background: Type 2 myocardial infarction is caused by myocardial oxygen supply-demand imbalance, and its diagnosis is increasingly common with the advent of high-sensitivity cardiac troponin assays. Although this diagnosis is associated with poor outcomes, widespread uncertainty and confusion remain among clinicians as to how to investigate and manage this heterogeneous group of patients with type 2 myocardial infarction. Methods: In a prospective cohort study, 8064 consecutive patients with increased cardiac troponin concentrations were screened to identify patients with type 2 myocardial infarction. We excluded patients with frailty or renal or hepatic failure. All study participants underwent coronary (invasive or computed tomography angiography) and cardiac (magnetic resonance or echocardiography) imaging, and the underlying causes of infarction were independently adjudicated. The primary outcome was the prevalence of coronary artery disease. Results: In 100 patients with a provisional diagnosis of type 2 myocardial infarction (median age, 65 years [interquartile range, 55–74 years]; 43% women), coronary and cardiac imaging reclassified the diagnosis in 7 patients: type 1 or 4b myocardial infarction in 5 and acute myocardial injury in 2 patients. In those with type 2 myocardial infarction, median cardiac troponin I concentrations were 195 ng/L (interquartile range, 62–760 ng/L) at presentation and 1165 ng/L (interquartile range, 277–3782 ng/L) on repeat testing. The prevalence of coronary artery disease was 68% (63 of 93), which was obstructive in 30% (28 of 93). Infarct-pattern late gadolinium enhancement or regional wall motion abnormalities were observed in 42% (39 of 93), and left ventricular systolic dysfunction was seen in 34% (32 of 93). Only 10 patients had both normal coronary and normal cardiac imaging. Coronary artery disease and left ventricular systolic dysfunction were previously unrecognized in 60% (38 of 63) and 84% (27 of 32), respectively, with only 33% (21 of 63) and 19% (6 of 32) on evidence-based treatments. Conclusions: Systematic coronary and cardiac imaging of patients with type 2 myocardial infarction identified coronary artery disease in two-thirds and left ventricular systolic dysfunction in one-third of patients. Unrecognized and untreated coronary or cardiac disease is seen in most patients with type 2 myocardial infarction, presenting opportunities for initiation of evidence-based treatments with major potential to improve clinical outcomes. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03338504.

The pathophysiology and trajectory of post-Coronavirus Disease 2019 (COVID-19) syndrome is uncertain. To clarify multisystem involvement, we undertook a prospective cohort study including patients who had been hospitalized with COVID-19 (ClinicalTrials.gov ID NCT04403607). Serial blood biomarkers, digital electrocardiography and patient-reported outcome measures were obtained in-hospital and at 28–60 days post-discharge when multisystem imaging using chest computed tomography with pulmonary and coronary angiography and cardio-renal magnetic resonance imaging was also obtained. Longer-term clinical outcomes were assessed using electronic health records. Compared to controls (n = 29), at 28–60 days post-discharge, people with COVID-19 (n = 159; mean age, 55 years; 43% female) had persisting evidence of cardio-renal involvement and hemostasis pathway activation. The adjudicated likelihood of myocarditis was ‘very likely’ in 21 (13%) patients, ‘probable’ in 65 (41%) patients, ‘unlikely’ in 56 (35%) patients and ‘not present’ in 17 (11%) patients. At 28–60 days post-discharge, COVID-19 was associated with worse health-related quality of life (EQ-5D-5L score 0.77 (0.23) versus 0.87 (0.20)), anxiety and depression (PHQ-4 total score 3.59 (3.71) versus 1.28 (2.67)) and aerobic exercise capacity reflected by predicted maximal oxygen utilization (20.0 (7.6) versus 29.5 (8.0) ml/kg/min) (all P < 0.01). During follow-up (mean, 450 days), 24 (15%) patients and two (7%) controls died or were rehospitalized, and 108 (68%) patients and seven (26%) controls received outpatient secondary care (P = 0.017). The illness trajectory of patients after hospitalization with COVID-19 includes persisting multisystem abnormalities and health impairments that could lead to substantial demand on healthcare services in the future.