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Background: Cardioversion is common among patients with atrial fibrillation (AF). We hypothesised that novel oral anticoagulants (NOAC) used in clinical practice resulted in similar rates of stroke compared with vitamin K antagonists (VKA) for cardioversion., Methods: Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II, patients with AF who had a cardioversion, follow-up data and an AF diagnosis within 6 months of enrolment were identified retrospectively. Clinical outcomes were compared for patients receiving a NOAC or VKA for 1 year following cardioversion., Results: Among 13 004 patients with AF, 2260 (17%) underwent cardioversion. 1613 met the inclusion criteria for this analysis. At the time of cardioversion, 283 (17.5%) were receiving a VKA and 1330 (82.5%) a NOAC. A transoesophageal echocardiogram (TOE) was performed in 403 (25%) cardioversions. The incidence of stroke/transient ischaemic attack (TIA) at 30 days was the same for patients having (3.04 per 100 patient-years) or not having (3.04 per 100 patient-years) a TOE (p=0.99). There were no differences in the incidence of death (HR 1.19, 95% CI 0.62 to 2.28, p=0.61), cardiovascular hospitalisation (HR 1.02, 95% CI 0.76 to 1.35, p=0.91), stroke/TIA (HR 1.18, 95% CI 0.30 to 4.74, p=0.81) or bleeding-related hospitalisation (HR 1.29, 95% CI 0.66 to 2.52, p=0.45) at 1 year for patients treated with either a NOAC or VKA., Conclusions: Cardioversion was a low-risk procedure for patients treated with NOAC, and there were statistically similar rates of stroke/TIA 30 days after cardioversion as for patients treated with VKA. There were no statically significant differences in death, stroke/TIA or major bleeding at 1 year among patients treated with NOAC compared with VKA after cardioversion., Competing Interests: Competing interests: BJG: member of a Data Safety Monitoring Board for Mount Sinai St Luke's, Boston Scientific, Teva Pharmaceutical Industries, St Jude Medical, Janssen Research & Development, Baxter Healthcare and Cardiovascular Research Foundation; consultant/Advisory Board for Janssen Scientific Affairs, Cipla, Armetheon and Medtronic. MDE: consultant/Advisory Board and grant support from Boehringer Ingelheim, Diachi Sanko, Pfizer, Bristol Myers Squibb and Janssen Scientific Affairs. PRK: consultant for Johnson and Johnson. JAR: research grant from Janssen Pharmaceuticals; research support from Boehringer Ingelheim Pharmaceuticals and GlaxoSmithKline; consultancies with Sanofi, Gilead Sciences, CV Therapeutics, GlaxoSmithKline, Merck & Co, Cardiome Pharma, Boehringer Ingelheim Pharmaceuticals and Medtronic; speakers bureau income from Sanofi and Boehringer Ingelheim Pharmaceuticals. GN: research grant from Janssen; consultant/Advisory Board for Janssen and Daiichi Sankyo. KWM: financial disclosures can be viewed at http://med.stanford.edu/profiles/kenneth-mahaffey. DES: consultant/Advisory Board for Boehringer Ingelheim, Bristol Myers Squibb, Merck, Johnson and Johnson, Pfizer and Medtronic; research grants from Boehringer Ingelheim and Bristol Myers Squibb. JF: consultant/Advisory Board for Janssen Scientific., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Long-term outcomes and predictors of mortality after implantable cardioverter-defibrillator (ICD) implantation related complication are unclear., Objective: The purpose of this study was to determine the risk of mortality and hospitalization after complication during ICD implantation and identify predictors of adverse outcomes., Methods: We performed a retrospective registry study of Medicare beneficiaries who were first-time ICD recipients enrolled in the National Cardiovascular Data Registry ICD Registry between January 2006 and March 2010. Mortality and hospitalization rates were examined using Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression analysis. Covariates associated with mortality 3 years after ICD implantation complication were investigated., Results: The study cohort comprised 136,143 Medicare beneficiaries. Complications during the index hospitalization occurred in 7046 patients (5.18%), and complications within 90 days of device implantation occurred in 10,005 patients (7.34%). In adjusted analyses, complications within 90 days of implantation were associated with an increased risk of all-cause mortality at 1 year (hazard ratio [HR] 1.13; 95% confidence interval [CI] 1.05-1.20; P = .006) and 3 years (HR 1.09; 95% CI 1.05-1.13; P <.0001). These results were consistent for a combined endpoint of all-cause mortality or hospitalization. Patient, device, and hospital characteristics associated with 3-year mortality were similar between those with and those without complications., Conclusion: Among Medicare beneficiaries, the occurrence of complications within 90 days of ICD implantation was associated with increased risk of all-cause mortality and all-cause mortality or hospitalization at 1 and 3 years. Patient, procedure, and hospital characteristics associated with mortality at 3 years after implantation were similar regardless of whether acute procedural complication occurred., (Published by Elsevier Inc.)

U.S. Forest Service managers are required to incorporate social and biophysical science information in planning and environmental analysis. The use of science is mandated by the National Environmental Policy Act, the National Forest Management Act, and U.S. Forest Service planning rules. Despite the agency's emphasis on 'science-based' decision-making, little is known about how science is actually used in recreation planning and management. This study investigated the perceptions of Forest Service interdisciplinary (ID) team leaders for 106 NEPA projects dealing with recreation and travel management between 2005 and 2008. Our survey data show how managers rate the importance of social and biophysical science compared to other potential 'success factors' in NEPA assessments. We also explore how team leaders value and use multi-disciplinary tools for recreation-related assessments. Results suggest that managers employ a variety of recreation planning tools in NEPA projects, but there appears to be no common understanding or approach for how or when these tools are incorporated. The Recreation Opportunity Spectrum (ROS) was the most frequently used planning tool, but the Visitor Experience and Resource Protection (VERP) framework was the most consistently valued tool by those who used it. We recommend further evaluation of the strengths and weaknesses of each planning tool and future development of procedures to select appropriate planning tools for use in recreation-related NEPA assessments.