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    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 Arzu
    Background/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.
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    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]
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    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, Naim
    BackgroundSodium-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.
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    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, Naim
    Background 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.