The prevalence of heart failure with preserved ejection fraction increased over a 15-year period, while the rate of death from this disorder remained unchanged. These trends underscore the importance of this growing public health problem.

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Background The relation between central obesity and survival in community-dwelling adults with a normal body mass index (BMI) is not well known. Objectives To examine the risk of total and cardiovascular mortality associated with central obesity but normal BMI Design Stratified multistage probability design Setting Third National Health and Nutrition Examination Survey Participants We analyzed data on 15,184 people (52.3% women) aged 18 to 90 years.. Measurements We used multivariable Cox proportional hazards model to evaluate the relation of obesity patterns defined by BMI and WHR and total and cardiovascular mortality risk after adjustment for confounding factors. Results Persons with normal-weight central obesity had the worst long-term survival: a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95% CI, 1.53–2.29]) and twice the mortality risk of participants who were overweight or obese by BMI only (HR, 2.24 [95% CI,1.52–3.32] and HR, 2.42 [95% CI, 1.30–4.53], respectively). Similarly, women with normal weight and central obesity had higher mortality risk than both women with similar BMI but no central obesity (HR, 1.48 [95% CI, 1.35–1.62]) and women who were obese by BMI only (HR, 1.32 [95% CI, 1.15–1.51]). Expected survival estimates were consistently lower for those with central obesity when controlled for age and BMI. Limitations Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report. Conclusion Normal-weight central obesity defined by WHR is associated with higher mortality than BMI–defined obesity, particularly in the absence of central fat distribution.

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BACKGROUND.Convalescent plasma is the only antibody-based therapy currently available for patients with coronavirus disease 2019 . It has robust historical precedence and sound biological plausibility. Although promising, convalescent plasma has not yet been shown to be safe as a treatment for COVID-19.METHODS. Thus, we analyzed key safety metrics after transfusion of ABO-compatible human COVID-19 convalescent plasma in 5000 hospitalized adults with severe or life-threatening COVID-19, with 66% in the intensive care unit, as part of the US FDA expanded access program for COVID-19 convalescent plasma. RESULTS.The incidence of all serious adverse events (SAEs), including mortality rate (0.3%), in the first 4 hours after transfusion was <1%. Of the 36 reported SAEs, there were 25 reported incidences of related SAEs, including mortality (n = 4), transfusion-associated circulatory overload (n = 7), transfusion-related acute lung injury (n = 11), and severe allergic transfusion reactions (n = 3). However, only 2 of 36 SAEs were judged as definitely related to the convalescent plasma transfusion by the treating physician. The 7-day mortality rate was 14.9%. CONCLUSION.Given the deadly nature of COVID-19 and the large population of critically ill patients included in these analyses, the mortality rate does not appear excessive. These early indicators suggest that transfusion of convalescent plasma is safe in hospitalized patients with COVID-19. TRIAL REGISTRATION. ClinicalTrials.gov NCT04338360.

Background-The long-term natural history of lone atrial fibrillation is unknown. Our objective was to determine the rate and predictors of progression from paroxysmal to permanent atrial fibrillation over 30 years and the long-term risk of heart failure, thromboembolism, and death compared with a control population. Methods and Results-A previously characterized Olmsted County, Minnesota, population with first episode of documented atrial fibrillation between 1950 and 1980 and no concomitant heart disease or hypertension was followed up long term. Of this unique cohort, 76 patients with paroxysmal (nϭ34), persistent (nϭ37), or permanent (nϭ5) lone atrial fibrillation at initial diagnosis met inclusion criteria (mean age at diagnosis, 44.2Ϯ11.7 years; male, 78%). Mean duration of follow-up was 25.2Ϯ9.5 years. Of 71 patients with paroxysmal or persistent atrial fibrillation, 22 had progression to permanent atrial fibrillation. Overall survival of the 76 patients with lone atrial fibrillation was 92% and 68% at 15 and 30 years, respectively, similar to 86% and 57% survival for the age-and sex-matched Minnesota population. Observed survival free of heart failure was slightly worse than expected (Pϭ0.051). Risk for stroke or transient ischemic attack was similar to the expected population risk during the initial 25 years of follow-up but increased thereafter (Pϭ0.004), although CIs were wide. All patients who had a cerebrovascular event had developed Ն1 risk factor for thromboembolism. Conclusions-Comorbidities

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