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Öğe Approaching a nationwide registry: analyzing big data in patients with heart failure(Tubitak Scientific & Technological Research Council Turkey, 2024) Colluoglu, Tugce; Sahin, Anil; Celik, Ahmet; Kanik, Emine ArzuBackground/aim: Randomized controlled trials usually lack generabilizity to real-world context. Real-world data, enabled by the use of big data analysis, serve as a connection between the results of trials and the implementation of findings in clinical practice. Nevertheless, using big data in the healthcare has difficulties such as ensuring data quality and consistency. This article aimed to examine the challenges in accessing and utilizing healthcare big data for heart failure (HF) research, drawing from experiences in creating a nationwide HF registry in T & uuml;rkiye. Materials and methods: We established a team including cardiologists, HF specialists, biostatistics experts, and data analysts. We searched certain key words related to HF, including heart failure, nationwide study, epidemiology, incidence, prevalence, outcomes, comorbidities, medical therapy, and device therapy. We followed each step of the STROBE guidelines for the preparation of a nationwide study. We obtained big data for the TRends-HF trial from the National Healthcare Data System. For the purpose of obtaining big data, we screened 85,279,553 healthcare records of Turkish citizens between January 1, 2016 and December 31, 2022. Results: We created a study cohort with the use of ICD-10 codes by cross-checking HF medication (n = 2,722,151). Concurrent comorbid conditions were determined using ICD-10 codes. All medications and procedures were screened according to ATC codes and SUT codes, respectively. Variables were placed in different columns. We employed SPSS 29.0, MedCalc, and E-PICOS statistical programs for statistical analysis. Phyton-based codes were created to analyze data that was unsuitable for interpretation by conventional statistical programs. We have no missing data for categorical variables. There was missing data for certain continuous variables. Propensity score matching analysis was employed to establish similarity among the studied groups, particularly when investigating treatment effects. Conclusion: To accurately identify patients with HF using ICD-10 codes from big data and provide precise information, it is necessary to establish additional specific criteria for HF and use different statistical programs by experts for correctly analyzing big data.Öğe The awareness, efficacy, safety, and time in therapeutic range of warfarin in the Turkish population: WARFARIN-TR(TURKISH SOC CARDIOLOGY, 2016) Celik, Ahmet; Izci, Servet; Kobat, Mehmet Ali; Ates, Ahmet Hakan; Cakmak, Abdulkadir; Cakilli, Yasin; Yilmaz, Mehmet Birhan; Zoghi, MehdiObjective: The awareness, time in therapeutic range (TTR), and safety of warfarin therapy were investigated in the adult Turkish population. Methods: This multicenter prospective study includes 4987 patients using warfarin and involved regular international normalized ratio (INR) monitoring between January 1, 2014 and December 31, 2014. TTR was calculated according to F.R. Roosendaal's algorithm. Awareness was evaluated based on the patients' knowledge of warfarin's affect and food-drug interactions. esults: The mean TTR of patients was 49.52 +/- 22.93%. The patients with hypertension (55.3%), coronary artery disease (23.2%), congestive heart failure (24.5%), or smoking habit (20.8%) had significantly lower TTR levels than the others. Of the total number of patients, 42.6% had a mechanical valve, 38.4% had non-valvular atrial fibrillation (AF), and 19% had other indications for warfarin. Patients with other indications had lower TTR levels than those with mechanical valve and non-valvular AF (p=0.018). Warfarin awareness decreased in higher age groups. The knowledge of warfarin's food-drug interactions was 55%. People with higher warfarin awareness had higher TTR levels. Patients with <= 8 INR monitoring/year had lower TTR levels (46.4 +/- 25.3 vs. 51.1 +/- 21.3, respectively, p<0.001) and lower awareness (44.6% vs. 60.6%, p<0.001) than patients with >= 8 INR monitoring/year. In this study, 20.1% of the patients had a bleeding event (major bleeding 15.8%, minor bleeding 84.2%) within a year. Conclusion: Both the mean TTR ratios and awareness of the Turkish population on warfarin therapy were found to be low. It was thought that low TTR levels of the Turkish population may be caused by the low awareness of warfarin, warfarin's food-drug interactions, and high rates of concomitant diseases.Öğe Deciphering mortality risk of diabetes medications in heart failure patients with diabetes mellitus under triple guideline-directed medical therapy(Elsevier Ireland Ltd, 2024) Colluoglu, Inci Tugce; Celik, Ahmet; Ata, Naim; Ural, Dilek; Sahin, Anil; Ulgu, Mustafa Mahir; Kanik, Emine ArzuBackground: Scientific evidence regarding the impact of different combinations of diabetes medications in heart failure patients with diabetes mellitus (HFwDM) remains limited. Aim: We aimed to investigate the effect of monotherapy and combination therapy for DM on all -cause mortality in HFwDM under triple guideline -directed medical therapy (GDMT). Method: This nationwide retrospective cohort study included adult HFwDM under triple GDMT between January 1, 2016 and December 31, 2022.We collected the data from the National Electronic Database of the Turkish Ministry of Health.We created various combination including different diabetes medications based on the current guidelines for DM.The primary endpoint was all -cause mortality. Results: A total of 321,525 HFwDM under triple GDMT (female:49%, median age:68[61 -75] years) were included. The highest rate of prescribed combination therapy was metformin and sulfonylureas ( n = 55,266). In Cox regression analysis, ins & uuml;lin monotherapy had the highest risk for all -cause mortality (HR:2.25, 95CI%:2.062.45), whereas combination therapy including metformin, SGLT2i, and sulfonylureas provided the most beneficial effect on survival (HR:0.29, 95CI%:0.22 -0.39) when compared to patients not receiving diabetes medication. Among patients taking diabetes medications, the inclusion of SGLT2i demonstrated a survival benefit ( p < 0.05), despite concurrent use of volume -retaining medications such as insulin and thiazolidinediones. Conversely, combinations of diabetes medications without SGLT2i did not demonstrate any survival benefit compared to patients not taking diabetes medication ( p > 0.05). Conclusion: This study underscored the use of SGLT2i as monotherapy or as a part of combination diabetes medications to improve survival among HFwDM, while also highlighting that combinations lacking SGLT2i did not confer any survival benefit.Öğe Development of a new magnetic solid-phase extraction method prior to HPLC determination of naproxen in pharmaceutical products and water samples(Elsevier, 2024) Karatas, Aysenur; Oymak, Tulay; Celik, AhmetIn this study, a new magnetic solid phase extraction based on magnetic composite modified with biochar obtained from pumpkin peel was developed for the enrichment and extraction of Naproxen in lake water, tablet and urine samples. The effects of main parameters such as pH, extraction time, amount of adsorbent and sample volume, which affect magnetic solid phase extraction, were investigated. Under optimal conditions, intraday and interday precision values for naproxen were below 5.9, with accuracy (relative error) better than 7.0 %. The detection limit and preliminary concentration factor were 12 ng/mL and 10, respectively. The method proposed here can be used for routine analysis of naproxen in lake water, urine and tablets.Öğe Establishment of interdisciplinary child protection teams in Turkey 2002-2006: Identifying the strongest link can make a difference!(PERGAMON-ELSEVIER SCIENCE LTD, 2009) Agirtan, Canan A.; Akar, Taner; Akbas, Seher; Akdur, Recep; Aydin, Cahide; Aytar, Gulsen; Ayyildiz, Suat; Baskan, Sevgi; Belgemen, Tugba; Bezirci, Ozdecan; Beyazova, Ufuk; Beyaztas, Fatma Yucel; Buken, Bora; Buken, Erhan; Camurdan, Aysu D.; Can, Demet; Canbaz, Sevgi; Canturk, Gurol; Ceyhan, Meltem; Coskun, Abdulhakim; Celik, Ahmet; Cetin, Fusun C.; Coskun, Ayse Gul; Dagcinar, Adnan; Dallar, Yildiz; Demirel, Birol; Demirogullari, Billur; Derman, Orhan; Dilli, Dilek; Ersahin, Yusuf; Esiyok, Burcu; Evinc, Gulin; Gencer, Ozlem; Gokler, Bahar; Hanci, Hamit; Iseri, Elvan; Isir, Aysun Baransel; Isiten, Nukhet; Kale, Gulsev; Karadag, Ferda; Kanbur, Nuray; Kilic, Birim; Kultur, Ebru; Kurtay, Derya; Kuruoglu, Asli; Miral, Suha; Odabasi, Aysun B.; Oral, Resmiye; Orhon, Filiz Simsek; Ozbesler, Cengiz; Ozdemir, Dilsad Foto; Ozkok, M. Selim; Ozmert, Elif; Oztop, Didem B.; Ozyurek, Hamit; Pasli, Figen; Peksen, Yildiz; Polat, Onur; Sabin, Figen; Sabin, Ahmet Rifat; Salacin, Serpil; Suskan, Emine; Tander, Burak; Tekin, Deniz; Teksam, Ozlern; Tiras, Ulku; Tomak, Yilmaz; Tumer, Ali Riza; Turla, Ahmet; Ulukol, Betul; Uslu, Runa; Tas, Fatma V.; Vatandas, Nilgun; Velipasaoglu, Sevtap; Yagmur, Fatih; Yagmurlu, Aydin; Yalcin, Songul; Yavuz, Sukruye; Yurdakok, KadriyeObjectives: The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. Methods: A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. Results: Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R-2 = 91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. Conclusions: A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. Practice implications: Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect. Published by Elsevier Ltd.Öğe Exploring Regional Disparities in Heart Failure Epidemiology and Outcomes: A Comprehensive Study Across Geographical Regions in Türkiye(Galenos Publ House, 2024) Sahin, Anil; Coellueoglu, Tugce; Celik, Ahmet; Ata, Naim; Yilmaz, Mehmet Birhan; Ural, Dilek; Kanik, ArzuBackground: Heart failure (HF) is a common condition that affects 1-3% of the general population. Its prevalence exhibits notable international and intranational disparities, partly explained by socioeconomic status, religion, ethnic diversity, and geographic factors. A comprehensive understanding of the epidemiological symptoms of HF in different regions of Turkiye has yet to be revealed. Aims: To examine epidemiological data from 2016 to 2022, focusing on crucial patient characteristics and geographical regions, to determine the incidence and prevalence of HF in Turkiye across seven diverse geographical regions.Study Design: A nationwide population-based retrospective cohort study.Methods: The comprehensive National Electronic Database of the Turkish Ministry of Health was used in this study to obtain data that covers the whole Turkish population from January 1, 2016, to December 31, 2022. The International Classification of Diseases-10 (ICD-10) codes were used to identify adults with HF (n = 2,701,099) and associated comorbidities. Turkiye is divided into seven geographically distinct regions. Epidemiological characteristics and survival data of these regions were analyzed separately. All-cause mortality was set as the primary outcome. Results: In , the total estimated prevalence of adult patients with HF is 2.939%, ranging from 2.442% in Southeastern Anatolia to 4.382% in the Black Sea Region. Except for the Eastern Anatolia Region, the three most often reported comorbidities were hypertension, dyslipidemia, and anxiety disorders. The rates of prescribing guideline-directed medical therapy (GDMT) for HF and other medications varied significantly. GDMT prescription rates were lowest in the Eastern Anatolia Region (82.6% for beta-blockers, 48.7% for RASi, 31.8% for mineralocorticoid receptor antagonists, and 9.4% for SGLT2i). The Mediterranean and Aegean regions had the highest median N-terminal brain natriuretic peptide (NT-proBNP) levels of 1,990,0 pg/ml (518.0-6,636,0) and 1,441,0 pg/ml (363.0-5,000,0), respectively. From 2016 to 2022, 915,897 (33.9%) of 2,701,099 patients died. The Eastern Anatolia Region had the lowest all-cause mortality rate of 26.5%, whereas the Black Sea Region had the highest all-cause mortality rate of 35.3%.Conclusion: Our real-world analysis revealed geographic disparities in HF characteristics, such as decreased mortality in socioeconomically challenged regions. Higher stress susceptibility in developed regions may increase the likelihood of adverse outcomes.Öğe Impact of implantable cardioverter defibrillators on mortality in heart failure receiving quadruple guideline-directed medical therapy: a propensity score-matched study(Bmc, 2024) Sahin, Anil; Celik, Ahmet; Ural, Dilek; Colluoglu, Inci Tugce; Ata, Naim; Kanik, Emine Arzu; Ulgu, Mustafa MahirBackgroundIn the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients.MethodsUtilizing deidentified data from the National Electronic Database of the Turkish Ministry of Health, we conducted a nationwide retrospective cohort study on 5450 HFrEF patients receiving quadruple GDMT, including ARNI. Among them, 709 patients underwent additional ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Propensity score matching ensured balanced baseline characteristics between groups. Primary endpoint was determined as all-cause mortality.ResultsIn the matched cohort, all-cause mortality occurred in 108 out of 619 patients (17.4%) in the GDMT group and 101 out of 619 patients (16.3%) in the ICD group, with a hazard ratio (HR) of 0.74 and a 95% confidence interval (CI) ranging from 0.57 to 0.98. The median follow-up time was 1365 days in the matched cohort, 1283 days in the GDMT group. Subgroup analyses consistently demonstrated benefits, particularly among individuals aged 61 years and older (HR: 0.60, 95% CI: 0.42-0.87, p = 0.006), those with sinus rhythm (HR: 0.55, 95% CI: 0.34-0.89, p = 0.013), individuals not using amiodarone (HR: 0.61, 95% CI: 0.42-0.89, p = 0.011), and those with an estimated glomerular filtration rate lower than 61.9 (HR: 0.66, 95% CI: 0.48-0.91, p = 0.011).ConclusionsThis study may offer a glimmer of hope that even after achieving the best current optimal medical therapy, the addition of device therapy could still yield positive outcomes in the management of patients with HFrEF.Öğe In Response to The Importance of Age Standardisation in Comparing Regional Inequalities(Galenos Publ House, 2025) Sahin, Anil; Colluoglu, Tugce; Celik, Ahmet; Ata, Naim; Yilmaz, Mehmet Birhan; Ural, Dilek; Kanik, Arzu[No abstract available]Öğe Medical and advanced heart failure therapies in Türkiye(Tubitak Scientific & Technological Research Council Turkey, 2024) Nalbantgil, Sanem; Demir, Emre; Celik, Ahmet; Colluoglu, Inci Tugce; Ata, Naim; Yilmaz, Mehmet Birhan; Sahin, AnilBackground/aim: Effective management of heart failure involves evidence-based use of multiple medications and their combinations. Furthermore, dosage escalation of the recommended medications is advised. In cases of advanced heart failure, long-term mechanical assistance devices or heart transplantation surgery may be necessary. Socio-economic disparities create unequal opportunities for people to access these treatments. The study aimed to analyze and compare medical and advanced heart failure treatments recommended by guidelines across various regions in T & uuml;rkiye. Materials and methods: About 85 million citizens medical treatment records were utilized between January 1, 2016, and December 31, 2022. Medical and heart replacement treatment opportunities for heart failure in T & uuml;rkiye were evaluated in the general population and across different geographical regions. Results: According to this study, beta-blockers were the most commonly prescribed medication for heart failure in T & uuml;rkiye. This was followed by angiotensin-converting enzyme inhibitors at 44% and mineralocorticoid receptor antagonists at 38.9%. However, only 0.6% of patients used angiotensin receptor blocker-neprilysin inhibitors. Despite the high incidence of diabetes mellitus among heart failure patients, only 11% used sodium-glucose cotransporter two inhibitors. The study also found that using an implantable cardioverter defibrillator (ICD) was 0.8%, and cardiac resynchronization therapy (CRT) was 0.3% among all intracardiac device treatments. Heart replacement therapies, cardiac transplantation surgery, and long-term left ventricle-assisted device (LVAD) surgery had very low rates. Conclusion: The use of guideline-directed medical therapy is not optimal in T & uuml;rkiye and varies across different geographical regions. It is a fact that heart transplant or LVAD surgery, CRT, and ICD implantation rates in T & uuml;rkiye are significantly lower than those in developed countries, regardless of geographical region.Öğe Muhammad Abduh's Approach to the Concept of Wisdom (Hikmah)(Anadolu Ilahiyat Akademisi, 2023) Ataman, Buket; Celik, AhmetMuhammad Abduh is a significant thinker who lived in Egypt during the peroiod of the new 'ilm al-kalam. His writings made an impact on Islamic philosophy. He aimed to provide the world of Islamic thought a fresh ra-tional perspective. He sought to arrive at the logical and scientific foundations of religion. In this regard, he valued knowledge of and access to data from modern science. By highlighting the significance of the connection between reason and science, Abduh hoped to make the role of religion more effective. because as time passed, the 19th century's conditions in the world and its mentality significantly changed. He created discourses against the Western world's misleading currents and philosophical tendencies against Islam for this reason. In his dis-courses, Abduh employed the concept of wisdom (hikmah) as a method. In response to the absolute rationalist and determinist interpretation of science that has been formed, particularly in the West in the current century, he believed it would be suitable to describe Islam with the concept of wisdom. Abduh desired that Muslims have a voice in all spheres, including sociology, psychology, science, and technology. Abduh struggled to accomplish these objectives as well as to revive and revitalize the structure of religious thought. He reflected on God's ac-tions, and those of His creatures, and the purposes of religion using the concept of wisdom as a tool and ap-proach. Instead than becoming caught down in specifics or theoretical discussions on the nature and attributes of God as in classical theology, he favored a different approach for this aim. For this reason, 'Abduh emphasized the value of reflecting on the wisdom and purposes of the texts as well as the creation as a whole. In his intel-lectual world, his goals were to establish a jurisprudence that is appropriate for the requirements of people, to grasp the meanings in the essence of creatures, to know the reasons of the creation of the universe, and to make accurate interpretations in accordance with the spirit of the Qur'an. He believed that using wisdom would be the best way to accomplish these objectives. Abduh attempted to combat fanaticism and imitation at the same time with his original interpretations and rationalist approaches brought about by wisdom. He claimed that wisdom, which is the sound knowledge, rules the will and motivates a person to take action. He placed more emphasis on wisdom's practical side, which motivates individuals to take action, than its theoretical one. Ac-cording to him, man is capable of knowing the true secrets of the Shari'ah with wisdom. Because a believer ought to be aware that religion entails understanding the wisdom behind the religious deeds, which entails submission to Allah. Reason can open the gates of ijtihad in Islamic thought. Man advances toward the original Creator of everything, the First Cause of all causes, in this way by correctly grasping the cause and effect rela-tionship in nature. On the basis of contemporary cosmological examples from the states of celestial bodies, Ab-duh-who gave the principle of causality a lot of weight-drew attention to the principle of cause and effect. He supported the causation, order, and rules in the natural laws using by this argument. He did not respect coinci-dences, stories, or mysteries, instead emphasizing the connection between wisdom and science. According to him, isdom is the pathway to religion; the power and rationale behind the particular order that rules the cosmos is appreciated. The prophets and the Qur'an were sent to make clear the monotheism's wisdom. Drawing a les -son from the creation will help a man reach tawheed (the unity of Gpd), and wisdom is the way to drwaing a lesson. These remarks demonstrate Abduh's acceptance of knowledge as a means of renewal religious thought. Compared to the traditional theological discourse of wisdom, this discourse is distinctive. Because there are several theoretical disputes in the traditional religious discourse of wisdom. On the other side, Abduh empha-sizes the kinship of religion and science with a different depth of wisdom and reflection on divine actions and creatures in an effort to encourage Muslims to raise in the face of the West.Öğe Navigating Heart Failure: Unveiling Sex Disparities in Guideline-Directed Medical Therapy Combinations(Excerpta Medica Inc-Elsevier Science Inc, 2024) Celik, Ahmet; Sahin, Anil; Ata, Naim; Colluoglu, Inci Tugce; Ural, Dilek; Kanik, Emine Arzu; Ayvali, Mustafa OkanMajor heart failure (HF) trials remain insufficient in terms of assessing the differences in clinical characteristics, biomarkers, treatment efficacy, and safety because of the underrepresentation of women. The study aimed to present sex-related disparities in HF management, including differences in demographics, co-morbidities, cardiac biomarkers, prescribed medications, and treatment outcomes. The study utilized anonymized data from and December 31, 2022. The cohort analysis included 2,501,231 adult patients with HF. Specific therapeutic combinations were analyzed using a Cox regression model to obtain relative risk reduction for all-cause death. The primary end point was all-cause mortality. In the cohort, 48.7% (n = 1,218,911) were male, whereas 51.3% (n = 1,282,320) were female. Female patients exhibited a higher median age (71 vs 68 years) and manifested higher prevalence of diabetes mellitus, anemia, atrial fibrillation, anxiety, and ischemic stroke. Male patients demonstrated higher rates of previous myocardial infarction, dyslipidemia, chronic obstructive pulmonary disease, and chronic kidney disease. Higher concentrations of natriuretic peptides were observed in female patients. Renin-angiotensin aldosterone inhibitor, b blockers, mineralocorticoid receptor antagonists, sodium/glucose cotransporter 2 inhibitor (SGLT2i), and ivabradine were more commonly prescribed in male patients, whereas loop diuretics, digoxin, and ferric carboxymaltose were more frequent in female patients. Male patients had higher rates of cardiac resynchronization therapy and implantable cardioverter defibrillator implantation rates. All-cause mortality and hospitalization rates were higher in male patients. Compared with monotherapy, all combinations, including SGLT2i, showed a beneficial effect on all-cause mortality in both female and male patients with HF. In hospitalized patients with HF, the addition of digoxin to renin-angiotensin aldosterone inhibitor, mineralocorticoid receptor antagonists, and b blockers was superior to monotherapy regarding all-cause mortality in female patients with HF compared with male patients with HF. In conclusion, this study highlights that sex-specific responses to HF medication combinations compared with monotherapy and differences in co-morbidities underscore the importance of tailored management strategies. Digoxin showed a contrasting effect on allcause mortality between both sexes after hospitalization, whereas SGLT2i exhibited a consistent beneficial effect in both sexes when added to all combinations. (c) 2024 Elsevier Inc. All rights reserved. (Am J Cardiol 2024;216:27-34)Öğe Outcomes of patients with heart failure in Turkiye(Tubitak Scientific & Technological Research Council Turkey, 2024) Sahin, Anil; Yilmaz, Mehmet Birhan; Celik, Ahmet; Colluoglu, Inci Tugce; Ural, Dilek; Asarcikli, Lale Dinc; Nalbantgil, SanemBackground/aim: Despite T & uuml;rkiye's relatively young population, there is an emerging trend of earlier diagnoses of chronic diseases, including heart failure (HF). This study aims to shed light on survival rates, potential influences of guideline-directed therapies, and sex-based differences necessitating personalized management in HF. Materials and methods: We conducted a nationwide retrospective cohort analysis of 2,722,151 patients with HF using deidentified data from the Turkish Ministry of Health's national electronic database. That cohort included 2,701,099 adult patients with HF. Adult patients were divided into two groups based on their outcomes as those who were deceased and those who survived and were then compared. Multivariate regression analysis was conducted to identify variables predicting mortality. The patients' hospital admissions and length of hospital stay were analyzed based on survival status and age. Results: Out of 2,722,151 HF patients, the overall mortality rate was 33.7%, with a difference observed according to sex (32.5% in female patients, 35.0% in male patients). Survival rates at 1, 5, and 7 years after the HF diagnosis were detailed. Deceased HF patients had more comorbidities, higher natriuretic peptides, and lower glomerular filtration rates. Hospitalization patterns varied, with 41% experiencing no hospitalization. The average length of hospital stay in 2022 was 6 days, with sex- and age-specific disparities. Conclusion: The survival rate of HF in T & uuml;rkiye is similar to world data. The survival of female patients is better than that of male patients. Increased survival rates can likely be attributed to the widespread use of guideline-directed therapies. Finally, high healthcare utilization is observed, especially in emergency situations.Öğe Real-Life Individual Comparison of Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Heart Failure and Diabetes Mellitus(Adis Int Ltd, 2025) Yilmaz, Mehmet Birhan; Celik, Ahmet; Colluoglu, Tugce; Sahin, Anil; Ural, Dilek; Kanik, Arzu; Ata, NaimBackgroundSodium-glucose cotransporter-2 inhibitors (SGLT2is) are breakthrough agents for the treatment of type 2 diabetes mellitus (T2DM) and heart failure (HF). However, among patients with HF and T2DM, some uncertainty remains about individual comparisons, including dosing.ObjectivesWe aimed to make a real-life individual comparison of SGLT2is among patients with HF and T2DM.MethodsThis was a subgroup analysis of the Turkish Ministry of Health's National Electronic Database for adult patients with HF (TRends-HF). All-cause mortality (ACM) data up to 7 years were evaluated. Patients with HF and T2DM who were prescribed an SGLT2i were identified, and individual doses of empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg were compared. For individual comparisons, propensity score-matching analysis was generated as 1:1:1, and disease-modifying therapies (DMTs) for HF were considered.ResultsIn the triple-matched cohort, 1-, 5-, and 7-year survival rates were 95%, 81%, and 76% versus 94%, 78%, and 72% versus 94%, 80%, and 75% for empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg, respectively. Among patients who were on triple DMT for HF, 1-, 5-, and 7-year survival rates were 95%, 78%, and 70% for empagliflozin 25 mg, 95%, 74%, and 66% for empagliflozin 10 mg, and 94%, 77%, and 69% for dapagliflozin, respectively. Annual emergency department visits were slightly lower with empagliflozin 10 mg and dapagliflozin 10 mg than with empagliflozin 25 mg. A greater proportion of patients on dapagliflozin 10 mg did not experience hospitalization during the 7-year follow-up compared with both doses of empagliflozin, albeit with a small effect size.ConclusionAmong patients with HF and T2DM, SGLT2is are instrumental, and empagliflozin 10 mg remains significantly inferior to dapagliflozin 10 mg and empagliflozin 25 mg in terms of 5- and 7-year ACM.Öğe The Evaluation of al-M?ward?'s Al?m al-nubuwwah as a Defense of Prophethood(Cumhuriyet Univ, Fac Theology, 2023) Celik, Ahmet; Gur, EyupProphethood (nubuwwah) is a divine institution that teaches the healthy progression of relations between Allah and humans, as well as between humans and the universe. However, from another perspective, it is also considered a human institution. Some opponents of religion, lacking strong evidence to challenge the existence of Allah, direct their objections towards prophethood, which is seen as a manifestation of Allah's attribute of speech (kalam). To counter the rejection of prophethood, scholars of theology (kalam), hadith, and Prophetic biography (sirah) have compiled a body of literature known as Dala'il al-nubuwwah (Proofs of Prophethood). Their aim has been to collect proofs supporting prophethood as a response to these refutations and to dispel doubts regarding it. All extraordinary events occurring from before the birth until the death of Prophet Muhammad are considered evidence.During the fifth century, a notable figure in this tradition was the ShafiMODIFIER LETTER LEFT HALF RINGi scholar al-Mawardi, who defended prophethood in his book AMODIFIER LETTER LEFT HALF RINGlam al-nubuwwah (The Signs of Prophethood). AMODIFIER LETTER LEFT HALF RINGlam alnubuwwah has inspired subsequent works in this field due to its clarity and robust proofs. It became known by both names, AMODIFIER LETTER LEFT HALF RINGlam al-nubuwwah and Dala'il alnubuwwah, as it encompassed methods of narration and debate.Within his work, al-Mawardi mentions figures like Barahimah, Dahriyyah, and certain philosophers as representatives of the idea rejecting prophethood. According to him, Barahimah, of Indian origin is a sect that denies prophethood despite accepting the unity of Allah. Dahriyyah is a denialist sect attributing eternity to the universe and creativity to nature. Al-Mawardi considers these philosophers as infidels due to their comments on prophethood rather than outright denial. The basis of these movements' idea of denying prophethood lies in their efforts to portray reason (MODIFIER LETTER LEFT HALF RINGaql) as an alternative to revelation (wahy). Jews and Christians, on the other hand, are portrayed as groups that accept the concept of prophethood, however they reject Muhammad's. prophecy. Their objection stems from the fear of their religions being superseded.Al-Mawardi counters those rejecting prophethood by addressing the public interest (maslahah) of humans, the necessity of prophets, and the role of miracles. He illustrates that prophet charged with the duty of prophethood proves it through spectacular events orchestrated by Allah but carried out through his own hand. The prophet serves the public interest by conveying matters beyond human intellect and presenting them in a comprehensible manner, thereby ensuring the worldly and eternal felicity of humanity. Furthermore, he provides evidence for the Prophet Muhammad's prophethood through his moral character, prophetic biography, and accounts of miracles. The biography of Prophet Muhammad's begins before his birth, and the method of proof In essence, al-Mawardi's method of proving prophethood in AMODIFIER LETTER LEFT HALF RINGlam al-nubuwwah can be seen as a synthesis of the approaches used by scholars of theology and hadith.Öğe Timing and Adherence Matter for Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure(Wiley, 2025) Yilmaz, Mehmet Birhan; Celik, Ahmet; Sahin, Anil; Colluoglu, Tugce; Ural, Dilek; Kanik, Arzu; Ata, NaimBackground It is imperative to maintain the use of sodium-glucose cotransporter-2 inhibitors (SGLT-2is) in patients with diabetes both after the index diagnosis of heart failure (HF) and even prior to the index diagnosis of HF. We aimed to investigate whether timing of SGLT-2 is before the index diagnosis of HF, and second, adherence to SGLT-2is in the form of the proportion of days covered metric matter in patients with HF and diabetes. Methods and Results All-cause death up to 7 years were evaluated in HF with diabetes from the subgroup analysis of TRends-HF (TRends in Heart Failure in T & uuml;rkiye). Patients with HF and diabetes, who were prescribed an SGLT-2i either before or after the index diagnosis of HF were identified, categorized according to duration of exposure before the index HF diagnosis and according to proportion of days covered after the index diagnosis of HF, and compared with nonusers. There were 1 229 833 patients with HF and diabetes in the cohort. A total of 247 987 were on an SGLT-2i and had available timing data, and 14.06% had SGLT-2i on board before the index HF diagnosis. Median duration of SGLT-2i exposure before the index HF diagnosis was 417 days. Prognosis was the best among patients with diabetes who were prescribed an SGLT-2i before the index diagnosis of HF with an exposure more than median duration. Of note, among patients who were prescribed an SGLT-2i after the index HF diagnosis; there was a numerically graded increase in all-cause mortality rate such that a >10% decrease in SGLT-2i proportion of days covered was associated with a 59% increase in all-cause death (hazard ratio, 1.21-2.09). Conclusions Regardless of time or adherence, SGLT-2is offer a remarkable all-cause death benefit to patients with HF and diabetes. SGLT-2is' all-cause death benefit for patients with HF and diabetes was greatest when it was prescribed before the HF index diagnosis. Poor adherence to SGLT-2is was associated with worsening survival in patients with HF and diabetes following the diagnosis of index HF.Öğe Trends in heart failure between 2016 and 2022 in Türkiye (TRends-HF): a nationwide retrospective cohort study of 85 million individuals across entire population of all ages(Elsevier, 2023) Celik, Ahmet; Ural, Dilek; Sahin, Anil; Colluoglu, Inci Tugce; Kanik, Emine Arzu; Ata, Naim; Arugaslan, EmreBackground Data on the burden of heart failure (HF) outside western countries are limited, but available data suggest it may present differently in other countries. The aim of this study was to examine the incidence, prevalence, and survival rates of HF in Turkiye, with a specific focus on how these rates vary according to age, sex, comorbidities, and socioeconomic status (SES).Methods We harnessed the extensive National Electronic Database of the Turkish Ministry of Health, covering Turkey's entire population from January 1, 2016, to December 31, 2022, to identify 2,722,151 cases of HF and their associated comorbidities using ICD-10 codes. Analyzing the primary endpoint of all-cause mortality, our study utilized anonymized data to examine patient demographics, comorbidities, socioeconomic status, and survival patterns, employing statistical techniques to delve into relationships and trends. The data were segmented by gender, socioeconomic status, and age, involving cross-tabulations and statistical metrics to explore connections, odds ratios, and survival rates.Findings The estimated prevalence of HF was 2.114% in Turkiye at the end of 2022, with an annual incidence ranging between 3.00 and 6.06 per 1000 person years. Females were older than males (69.8 +/- 13.9 years vs. 66.8 +/- 13.9 years, respectively). The most common comorbidities were congenital heart diseases and anemia under the age of 20, and hypertension and atherosclerotic cardiovascular disease in the adult population. Only 23.6% (643,159/2,722,151) of patients were treated with any triple guideline-directed medical therapy (GDMT) and 3.6% (96,751/2,722,151) of patients were on quadruple GDMT. The survival rates for patients with HF at 1, 5, and 7 years were 83.3% (95% CI: 83.2-83.3), 61.5% (95% CI: 61.4-61.6), and 57.7% (95% CI: 57.6-57.8) among females, and 82.1% (95% CI: 82.0-82.2), 58.2% (95% CI: 58.1-58.3), and 54.2% (95% CI: 54.0-54.3) among males. Despite a tendency for an increase from the highest to the lowest SES, the prevalence of HF and mortality were paradoxically lowest in the lowest SES region.Interpretation The prevalence, incidence, and survival rates of HF in Turkiye were comparable to western countries, despite the notable difference of HF onset occurring 8-10 years earlier in the Turkish population. Drug usage statistics indicate there is a need for effective strategies to improve treatment with GDMT.Öğe Vaccination of adults with heart failure and chronic heart conditions: Expert opinion(TURKISH SOC CARDIOLOGY, 2018) Celik, Ahmet; Altay, Hakan; Azap, Alpay; Cavusoglu, Yuksel; Nalbantgil, Sanem; Senol, Esin; Temizhan, Ahmet; Yilmaz, Mehmet Birhan…Öğe What have we learned from Turkish familial hypercholesterolemia registries (A-HIT1 and A-HIT2)?(ELSEVIER IRELAND LTD, 2018) Kayikcioglu, Meral; Tokgozoglu, Lale; Dogan, Volkan; Ceyhan, Ceyhun; Tuncez, Abdullah; Kutlu, Merih; Onrat, Ersel; Alici, Gokhan; Akbulut, Mehmet; Celik, Ahmet; Yesilbursa, Dilek; Sahin, Tayfun; Sonmez, Alper; Ozdogan, Oner; Temizhan, Ahmet; Kilic, Salih; Bayram, Fahri; Sabuncu, Tevfik; Coskun, Fatma Yilmaz; Ildizli, Muge; Durakoglugil, Emre; Kirilmaz, Bahadir; Yilmaz, Mehmet Birhan; Yigit, Zerrin; Yildirim, Aytul Belgi; Gedikli, Omer; Topcu, Selim; Oguz, Aytekin; Demir, Mesut; Yenercag, Mustafa; Yildirir, Aylin; Demircan, Sabri; Yilmaz, Mehmet; Kaynar, Leyla Gul; Aktan, Melih; Durmus, Rana Berru; Gokce, Cumali; Ozcebe, Osman Ilhami; Akyol, Tulay Karaagac; Okutan, Harika; Sag, Saim; Gul, Ozen Oz; Salcioglu, Zafer; Altunkeser, Bulent Behlul; Kuku, Irfan; Yasar, Hurriyet Yilmaz; Kurtoglu, Erdal; Kose, Melis Demir; Demircioglu, Sinan; Pekkolay, Zafer; Ilhan, Osman; Can, Levent H.Background and aims: Familial hypercholesterolemia (FH) is a common genetic disease of high-level cholesterol leading to premature atherosclerosis. One of the key aspects to overcome FH burden is the generation of largescale reliable data in terms of registries. This manuscript underlines the important results of nation-wide Turkish FH registries (A-HIT1 and A-HIT2). Methods: A-HIT1 is a survey of homozygous FH patients undergoing low density lipoprotein (LDL) apheresis (LA). A-HIT2 is a registry of adult FH patients (homozygous and heterozygous) admitted to outpatient clinics. Both registries used clinical diagnosis of FH. Results: A-HIT1 evaluated 88 patients (27 +/- 11 years, 41 women) in 19 centers. All patients were receiving regular LA. There was a 7.37 +/- 7.1-year delay between diagnosis and initiation of LA. LDL-cholesterol levels reached the target only in 5 cases. Mean frequency of apheresis sessions was 19 +/- 13 days. None of the centers had a standardized approach for LA. Mean frequency of apheresis sessions was every 19 +/- 13 (7-90) days. Only 2 centers were aware of the target LDL levels. A-HIT2 enrolled 1071 FH patients (53 +/- 8 years, 606 women) from 31 outpatients clinics specialized in cardiology (27), internal medicine (1), and endocrinology (3); 96.4% were heterozygous. 459 patients were on statin treatment. LDL targets were attained in 23 patients (2.1% of the whole population, 5% receiving statin) on treatment. However, 66% of statin-receiving patients were on intense doses of statins. Awareness of FH was 9.5% in the whole patient population. Conclusions: The first nationwide FH registries revealed that FH is still undertreated even in specialized centers in Turkey. Additional effective treatment regiments are urgently needed.Öğe Why has the incidence of heart failure decreased by half in Türkiye?-Authors' reply(Elsevier, 2023) Celik, Ahmet; Colluoglu, Inci Tugce; Sahin, Anil; Ural, Dilek; Yilmaz, Mehmet Birhan; Ataf, Naim[Abstract Not Available]
