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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 Atherogenic indexes versus hematologic inflammatory indexes: What is the most useful predictor of coronary slow flow?(Bayrakol Medical Publisher, 2021) Dindas, Ferhat; Koyun, Emin; Cerik, Idris Bugra; Sahin, Anil; Kilit, Celal; Dogdus, MustafaAim: Previous studies reported that inflammation and atherosclerosis are linked to coronary slow flow (CSF). The predominant pathological mechanism has not been elucidated yet. Hence, we aimed to compare hematologic inflammatory and atherogenic indexes simultaneously between patients with normal coronary flow (NCF) and CSF. Material and Methods: In a single-center retrospective analysis, 91 consecutive NCF patients and 90 consecutive CSF patients constituted two groups according to Thrombolysis in Myocardial Infarction frame count (TFC). Hematological indexes consist of the neutrophil-lymphocyte ratio (NLR), the lymphocyte to monocyte ratio (LMR), and the platelet-lymphocyte ratio (PLR), and the atherogenic indexes consist of an atherogenic index of plasma (AIP), atherogenic coefficient (AC), and Castelli's risk index (CRI). Baseline clinical parameters were compared beside the indexes. Results: NLR, LMR, PLR were similar in groups. AIP, AC and CRI were significantly higher in the CSF group (p<0.05). In correlation analysis, only CRI has significantly positive correlation with mean TFC (r: 0.419 p <0.001). In multivariate regression analysis, CRI was found as independently predictor of CSF (Odds ratio = 2.74, 95% CI = 1.21-6.207; p=0.016). Discussion: An elevated CRI may be an independent predictor for the presence of CSF. Additionally, it can be said that the inflammatory activity in CSF is transformed into atherosclerotic structures.Öğe Burden of comorbidities in heart failure patients in TUrkiye(Tubitak Scientific & Technological Research Council Turkey, 2024) Cavusoglu, Yuksel; Murat, Selda; Sahin, Anil; Colluoglu, Inci Tugce; Ural, Dilek; Yilmaz, Mehmet Birhan; Nalbantgil, SanemBackground/aim: Heart failure (HF) is associated with a wide range of comorbidities that negatively impact clinical outcomes and cause high economic burden. We aimed to evaluate the frequency and burden of comorbidities in HF patients in Turkiye and their relationships with patients' demographic characteristics. Materials and methods: Based on ICD-10 codes in the national electronic database of the Turkish Ministry of Health covering the entire population of Turkiye (n = 85,279,553) from 1 January 2016 to 31 December 2022, data on the prevalence of comorbidities in HF patients were obtained. The frequency and burden of comorbidities were analyzed separately by age groups, sex, and socioeconomic status (SES). Results: Between 2016 and 2022, there were 2,722,151 patients (51.7% female) of all ages who were diagnosed with HF. In Turkiye, the most common comorbidities of HF patients were hypertension (HT) (97.6%), atherosclerotic cardiovascular disease (ASCVD) (84.9%), dyslipidemia (59.5%), anxiety disorder (48.1%), diabetes mellitus (DM) (45.2%), chronic obstructive pulmonary disease (COPD) (43.6%), anemia (40.6%), and atrial fibrillation (AF) (37.1%). Female patients had higher rates of anemia, DM, HT, and anxiety disorders, while male patients had higher rates of ASCVD, COPD, and dyslipidemia. The most common comorbidity in patients under 20 years of age was congenital heart disease (52.3%). More than 90% of HF patients had >= 2 comorbidities. HF patients with >= 5 comorbidities increased from 18.1% in the group aged 20-49 years to 38.3% in the group aged 50-79 years. Comorbidities were similar across SES groups. Conclusion: The most common comorbidities in cases of HF in Turkiye are HT, ASCVD, dyslipidemia, DM, COPD, anemia, and AF, respectively, and more than 90% of patients have >= 2 comorbidities. While ASCVD and dyslipidemia were more common in male patients, anemia, DM, and anxiety disorders were more common in female patients. The number of comorbid conditions increased with advanced age.Öğe CAN FRONTAL QRS-T ANGLE PREDICT MORTALITY IN PATIENTS WITH SEVERE CRIMEAN-CONGO HEMORRHAGIC FEVER?(Dokuz Eylul Univ Inst Health Sciences, 2023) Sahin, Anil; Gundogdu, Oguz; Avci, OnurPurpose: This study aims to determine whether frontal QRS-T (fQRS-T) angle measurements assist in predicting prognosis in severe CCHF (Crimean-Congo Hemorrhagic Fever) patients. Material and Method: The study was conducted with 140 intensive care patients diagnosed with CCHF between 01.01.2012 and 2022. Demographic data and length of stay were recorded. In addition, laboratory data were recorded, including hemoglobin, troponin T, C-reactive protein, lymphocyte numbers, neutrophil, and platelet. fQRS-T angles were measured on electrocardiographic (ECG) data of the patients. Results: The mean fQRS-T angle was 53.9 degrees +/- 29.3 degrees in non-survivors and 34.2 degrees +/- 17.3 degrees in the survivors (p<0.001). Regarding non-survivors, they were older, and their hemoglobin, platelet and lymphocyte levels were lower (p<0.001), and their QRS durations were broader (p=0.021) than survivors. The fQRS-T angle cutoff value in predicting mortality was determined as 41.5 degrees. For fQRS-T >= 41.5 degrees, specificity was 61.1%, and sensitivity was 80.9% (area under the curve: 0.711, 95% CI: 0.624-0.798, p<0.001). Conclusion: Current study's results showed the usability of the fQRS-T angle as an inexpensive, convenient, strong, and repeatable predictor to determine the prognosis of CCHF patients. A detailed electrocardiographic evaluation in the routine follow-up of high-risk CCHF patients may indicate the prognosis of the disease.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 Diagnostic approach to heart failure in Turkiye(Tubitak Scientific & Technological Research Council Turkey, 2024) Ural, Dilek; Asarcikli, Lale Dinc; Colluoglu, Inci Tugce; Sahin, Anil; Cavusoglu, Yuksel; Yilmaz, Mehmet Birhan; Nalbantgil, SanemBackground/aim: Final diagnosis of heart failure (HF) relies on a combination clinical findings, laboratory and imaging tests. The aim of this study was to review the diagnostic approach to HF in Turkiye. Materials and methods: This study is a subanalysis of the nationwide TRends-HF study, based on anonymized data from National Electronic Database between January 1, 2016, and December 31, 2022. Variables including date of birth, sex, socioeconomic development index, place of initial HF diagnosis, comorbidities, investigations, and diagnostic procedures were reported. Laboratory variables, including complete blood count, natriuretic peptides (NP), estimated glomerular filtration rate, uric acid, electrolytes, albumin, lipid profile, ferritin and hemoglobin A1c levels, and other imaging techniques (coronary angiogram [CAG], transthoracic echocardiography [TTE], chest X-ray [CXR], etc.) during the initial diagnosis and/or follow-up of HF patients, were obtained from the National Electronic Database. The diagnostic test usage rates were analyzed according to years, geographical regions, and socioeconomic regions of Turkiye. Results: The study population consisted of 2,722,151 HF patients (51.7% female, mean age 68.33 +/- 14.01 years). All HF patients had at least one electrocardiogram and one TTE examination, and all underwent routine biochemical tests at least once during the followup period. CXR utilization rate was 93.7%, while CAG utilization rate was 17.9%. Coronary computed tomographic angiography and cardiac magnetic resonance imaging were performed in only 1.8% and 0.3% of patients, respectively. Among all Turkish HF patients, 16.3% had at least one NP measurement. The highest rate of NP use was observed in the Central Anatolia Region (21.0%), while the lowest rate was in the Aegean Region (11.7%). NP measurement during HF diagnosis revealed a rising trend over time (12.3% in 2016 vs. 26.3% in 2021). Conclusion: The widespread use of TTE at the beginning of the diagnosis and during follow-up is important for providing quality care to HF patients in Turkiye. However, detailed laboratory tests and advanced imaging methods are not utilized sufficiently, which could lead to issues in patient management.Öğe Düşük Ejeksiyon Fraksiyonlu Kalp Yetersizliği Hastalarında Bendopne ile Atriyal Fibrilasyon İlişkisi(2024) Sahin, Anil; Yılmaz Öztekin, Gülsüm Meral; Genç, Ahmet; Kaya, Hakkı; Yılmaz, Mehmet BırhanAmaç: Bendopne, yüksek intrakardiyak dolum basınçlarına bağlı olarak ortaya çıkan semptomlardan biridir ve kalp yetersizliği (KY) seyri sırasında olumsuz sonuçlarla ilişkilidir. Benzer şekilde, atriyal fibrilasyon (AF) genellikle KY ile birlikte görülen ve kliniği olumsuz etkileyen bir durumdur. KY'li hastalarda bendopne ile AF arasındaki ilişki net olarak bilinmemektedir. Hem bendopne hem de atriyal fibrilasyonun patofizyolojisinde artan intrakardiyak dolum basınçlarının rol oynadığı açıktır. Bu nedenle, bu çalışmayı düşük ejeksiyon fraksiyonlu kalp yetersizliği (DEF KY) hastalarında AF ve bendopne arasındaki olası ilişkiyi belirlemek amacıyla planladık. Gereç ve Yöntem: Bu çalışma, DEF KY’li ambulatuvar hastalarda çok merkezli, geriye dönük bir gözlemsel çalışma olarak planlanmıştır. Bendopne testi için hastalar otururken, çorap veya ayakkabı giyer gibi öne doğru eğilmeleri istendi ve araştırmacı, hastanın ifadelerine göre nefes darlığının başlangıç zamanını belirledi. Hastalar, eğildikten sonra 30 saniye içinde nefes darlığı bildirdiyse bendopne var olarak kabul edildi. Bulgular: Çalışma popülasyonundaki 694 hastanın medyan yaşı 66 (58 75) idi. Hastaların 211’i (%30,4) kadındı, ortalama sol ventrikül ejeksiyon fraksiyonu %31 idi. 279 hastada (%40,2) NYHA fonksiyonel sınıf III IV idi. KY tanısından indeks muayeneye kadar geçen süre ortalama 24 aydı. Atriyal fibrilasyon oranı, bendopnesi olan hasta grubunda istatistiksel olarak anlamlı derecede daha yüksek bulundu (%28’e karşı %18, p=0,020). Yapılan çoklu lojistik regresyon analizinde DEF KY olan hastalarda AF ile bendopne arasında anlamlı ilişki mevcut olduğu saptandı (HR: 2.71, 9%5 GA: 1.10 6.69, p=0.030). Sonuç: Çalışmamızda, bendopneye sahip hastalarda atriyal fibrilasyon insidansının daha yüksek olduğunu bulduk. Bendopnesi olan hasta grubundaki artmış sistolik pulmoner arter basıncı, olumsuz atriyal yeniden şekillenme ve artmış atriyal basınçların bu sonuçlara neden olabileceğini düşündürmektedir. Ancak bendopne ile AF arasındaki ilişkiyi daha detaylı incelemek için geniş çaplı çalışmalara ihtiyaç vardır.Öğe Effect of Bendopnea on Achievement Medical Treatment Target Doses in Heart Failure(Acad Medical Sciences I R Iran, 2023) Oztekin, Gulsum Meral Yilmaz; Genc, Ahmet; Sahin, Anil; Cagirci, Goeksel; Arslan, SakirBackground: The newly described bendopnea in heart failure (HF) is associated with increased cardiac filling pressures. The aim of the study was to show the effect of bendopnea follow-up on reaching optimal medical treatment doses in HF. Methods: A total of 413 patients were screened, and we included 203 patients with HF who were previously evaluated for bendopnea. Demographic data, presence or absence of bendopnea, medical history, laboratory findings, and medical treatments were evaluated. Optimal medical therapy target doses at baseline and 3rd month were compared in groups with and without bendopnea. Results: On admission, 64 patients (31.5%) had bendopnea. The rate of patients with bendopnea decreased in the 3rd month (n = 42, 20.7%). The proportion of patients who used at least 50% of the recommended medical treatment dose on admission and in the 3rd month was compared; angiotensin-converting enzyme inhibitor /angiotensin receptor blockers use increased from 40.6% to 71.9% in those with bendopnea (P = 0.013), from 56.1% to 81.3% in those without bendopnea (P < 0.001) and beta-blockers use increased from 28.2% to 60.9% in those with bendopnea (P = 0.042), from 31.6% to 69.8% in those without bendopnea (P < 0.001). However, aldosterone antagonists use decreased from 70.3% to 67.2% in those with bendopnea (P = 0.961), from 68.4 % to 64.1% in those without bendopnea (P = 0.334). Bendopnea was independently effective in achieving ACE-I/ARB target doses (OR: 0.359, CI 95%: 0.151-0.854, P = 0.020). Conclusion: Bendopnea follow-up in HF patients can provide a significant improvement in reaching the recommended treatment target doses.Öğe Effects of the perimenopausal period on the course of heart failure(Cukurova Univ, Fac Medicine, 2023) Sahin, Emine Tugce; Oztekin, Gulsum Meral Yilmaz; Genc, Ahmet; Sahin, Anil; Ozen, MehmetPurpose: It is known that the decrease in estrogen level in women's life has negative effects on the cardiovascular system. In this study, it was aimed to elucidate the changes in the clinical status and treatment requirement of patients with heart failure (HF) during the menopausal transition period.Materials and Methods: A total of 26 patients followed up in the HF outpatient clinic between 2015-2020 were included in this retrospective, single-center study. Demographic data of the patients, New York Heart Association class, echocardiographic findings, routine biochemical parameters and HF signs, symptoms and therapies were examined. Data at the beginning of the menopause period and after 12 months were compared.Results: At the end of the 12-month follow-up, a statistically significant increase was found in the daily dose of furosemide (50.5 mg/day vs. 72.4 mg/day). While the mean heart rate of the patients was 80.4 +/- 20.1 beats/min at the beginning, it was 69.3 +/- 10.1 beats/min in the control visit. Echocardiographically measured left ventricular (LV) systolic diameters of the patients were significantly increased compared to baseline in the control visit (41.2 +/- 7.4 mm vs 45.8 +/- 7.0 mm,).Conclusion: The menopausal period caused an increase in the need for treatment in patients followed up with HF. Therefore, in evaluation of the patients with HF, it would be a useful approach to question the menopausal status in detail and to follow the patients more closely during the menopausal transition period.Öğe Electrocardiographic Prognostic Marker in Pulmonary Arterial Hypertension: RS Time(Arquivos Brasileiros Cardiologia, 2024) Koyun, Emin; Sahin, Anil; Yilmaz, Ahmet; Dindas, Ferhat; Cerik, Idris Bugra; Koyun, Gorkem BernaBackground: Pulmonary hypertension is a condition that involves the remodeling of the right ventricle. Ongoing remodeling is also associated with disease prognosis. During the restructuring process, complex changes such as hypertrophy and dilatation may also be reflected in electrocardiographic parameters. Objectives: Our study aimed to investigate the relationship between prognosis and electrocardiographic parameters in patients with pulmonary arterial hypertension. Methods: The study was designed retrospectively and included patients diagnosed with pulmonary arterial hypertension between 2010 and 2022. The patients were divided into two groups based on their survival outcome. Various parameters, including electrocardiographic, demographic, echocardiographic, catheter, and blood parameters, were compared between the two groups. A p-value of <0.05 was considered statistically significant. Results: In the multivariate Cox analyses, the parameters that were found to be independently associated with survival were the 6-minute walk test, mean pulmonary artery pressure, presence of pericardial effusion, and time between the beginning of the QRS and the peak of the S wave (RS time) (p<0.05 for each). Of all the parameters, RS time demonstrated the best diagnostic performance (AUC:0.832). In the survival analysis, a significant correlation was found between RS time and survival when using a cut-off value of 59.5 ms (HR: 0.06 [0.02-0.17], p < 0.001). Conclusions: According to the results of our study, a longer RS time is associated with poor prognosis in patients with pulmonary arterial hypertension. We can obtain information about the course of the disease with a simple, non-invasive parameter.Öğe Electrocardiographic Prognostic Marker in Pulmonary Arterial Hypertension: RS Time [2](Arquivos Brasileiros Cardiologia, 2024) Koyun, Emin; Sahin, Anil; Yilmaz, Ahmet; Dindas, Ferhat; Cerik, Idris Bugra; Koyun, Gorkem BernaBackground: Pulmonary hypertension is a condition that involves the remodeling of the right ventricle. Ongoing remodeling is also associated with disease prognosis. During the restructuring process, complex changes such as hypertrophy and dilatation may also be reflected in electrocardiographic parameters. Objectives: Our study aimed to investigate the relationship between prognosis and electrocardiographic parameters in patients with pulmonary arterial hypertension. Methods: The study was designed retrospectively and included patients diagnosed with pulmonary arterial hypertension between 2010 and 2022. The patients were divided into two groups based on their survival outcome. Various parameters, including electrocardiographic, demographic, echocardiographic, catheter, and blood parameters, were compared between the two groups. A p-value of <0.05 was considered statistically significant. Results: In the multivariate Cox analyses, the parameters that were found to be independently associated with survival were the 6-minute walk test, mean pulmonary artery pressure, presence of pericardial effusion, and time between the beginning of the QRS and the peak of the S wave (RS time) (p<0.05 for each). Of all the parameters, RS time demonstrated the best diagnostic performance (AUC:0.832). In the survival analysis, a significant correlation was found between RS time and survival when using a cut-off value of 59.5 ms (HR: 0.06 [0.02-0.17], p < 0.001). Conclusions: According to the results of our study, a longer RS time is associated with poor prognosis in patients with pulmonary arterial hypertension. We can obtain information about the course of the disease with a simple, non-invasive parameter.Öğe Epidemiology of heart failure in Turkiye(Tubitak Scientific & Technological Research Council Turkey, 2024) Ata, Naim; Colluoglu, Inci Tugce; Sahin, Anil; Yilmaz, Mehmet Birhan; Nalbantgil, Sanem; Birinci, Suayip; Ulgu, Mustafa MahirBackground/aim: The epidemiological data on heart failure (HF) vary between regions within the same country. We aimed to investigate the epidemiological data on HF in Turkiye across all age groups regarding seven geographical regions. Materials and methods: We included all patients from the Turkish population who received a first diagnosis of HF between January 1, 2016 and December 31, 2022, using ICD-10 codes from the National Electronic Healthcare Database. The data were categorized by seven geographical regions of Turkiye. Results: The median age of index diagnosis of HF was 70 (60-78) years in all age groups and 4 (1-12) years in pediatric population. The prevalence rate of HF was the highest in the Black Sea Region at 3.103%, while the Southeastern Anatolia Region exhibited the lowest at 1.436%. In all age groups, female patients with HF were older and had a higher prevalence rate across all geographical regions than male patients. From 2017 to 2021, incidence rates of HF declined to 3.0 per 1000 person years, with a consistent decrease for each geographical region. The highest incidence rates of HF were seen in the Black Sea Region, while the Southeastern Anatolia Region had the lowest. Evaluating pediatric population with HF, prevalence of HF was 0.81 per 1000 people (female children: 0.77 per 1000 people, male children: 0.84 per 1000 people). Female children with HF demonstrated the highest prevalence in the Central Anatolia Region with a rate of 1.04 per 1000 people, while male pediatric population with HF exhibited the greatest prevalence of HF in the Mediterranean Region, reaching 0.89 per 1000 people. The lowest prevalence of children with HF in both sexes was observed in the Eastern Anatolia Region (female children: 0.62 per 1000 people, male children: 0.48 per 1000 people). Conclusion: Despite regional variations, prevalence of HF in Turkiye's regions aligns with global trends. Sex-based differences in HF prevalence were evident across all age groups, including pediatric population. Incidence rates of HF in each region exhibited a substantial decline by 2021.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 Mortality predictor in heart failure patients with preserved ejection fraction: pulmonary artery pulsatility index(Taylor & Francis Ltd, 2024) Koyun, Emin; Sahin, Anil& Idot;ntroduction: The pathophysiology of heart failure with preserved ejection fraction has not been clearly elucidated. Therefore, there is not enough information about the prediction of poor prognosis in these patients. Our aim is to investigate whether the pulmonary artery pulsatile index, derived from right heart catheterisation parameters, is associated with mortality in these patients. Materials and methods: The study was designed retrospectively. Patients who underwent right heart catheterisation between 2016 and 2023 and were diagnosed with heart failure with preserved ejection fraction were included in the study. The patients were divided into 2 groups. Dead patients were included in the first group, and surviving patients were included in the second group. Basic characteristics, right heart catheterisation results, pre-catheter blood and echocardiography parameters, and pulmonary artery pulsatile index were compared between both groups. Results: Pulmonary artery pulsatile index, mean pulmonary artery pressure, and body mass index were found to be independent predictors of mortality in heart failure patients with preserved ejection fraction. A PAPi value of <2.84 was found to have 76.2% sensitivity and 77% specificity in predicting mortality in heart failure patients with preserved ejection fraction. Conclusion: This study shows how important the pulmonary artery pulsatile index is in predicting mortality in heart failure patients with preserved ejection fraction. Since low levels of pulmonary artery pulsatile index at the time of diagnosis may predict poor prognosis, importance should be given to follow-up and treatment in these patients. Routine use of this index may contribute to reducing mortality and morbidity in patients.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 New prognostic markers in pulmonary arterial hypertension: CRP to albumin ratio and uric acid(Pergamon-Elsevier Science Ltd, 2022) Cerik, Idris Bugra; Dindas, Ferhat; Koyun, Emin; Dereli, Seckin; Sahin, Anil; Turgut, Okan Onur; Gul, IbrahimIntroduction: Idiopathic pulmonary hypertension(IPAH) is a rare disease that causes severe morbidity and mortality despite advances in treatment management. Evaluating the prognosis of the disease is critical in determining therapeutic approaches. We aimed to evaluate the prognostic significance of C-reactive protein/albumin ratio (CAR) and uric acid, which is an easily applicable and inexpensive parameter in patients with IPAH. Methods: Seventy-two IPAH patients and 99 consecutive non-IPAH patients as a control group were enrolled in the study retrospectively. Right heart catheterization(RHC), echocardiography, and laboratory parameters of the two groups and those who died and survived among the IPAH patients were compared. Results: IPAH and control group were compared at the first stage and CAR (1.98(0.28-10.74), 0.75(0.22-4.7), respectively;p < 0.01) and uric acid (0.33(0.19-0.87), 0.3(0.11-0.48) mmol/L, respectively; p = 0.03) values were significantly higher in the pulmonary hypertension group compared to the control group. Compared with the surviving IPAH patients, CAR (4.60(1.39-10.74),1.54(0.28-6.74),respectively;p < 0.001) and uric acid levels (0.458(0.26-0.87), 0.315(0.19-0.56) mmol/L, respectively; p < 0.001) were significantly higher in the group of patients who died. In the multivariate Cox regression models uric acid(p < 0.001) and CAR(p < 0.001) were found to be associated with survival time. Receiver operating characteristic curves (ROC) analyses showed that > 1.54 CAR value (AUC = 0.81,Sens:85.7%,Spec:56.9%,p < 0.001) and > 5.85 mg/dL (>0.348 mmol/L) uric acid value (AUC = 0.864, Sens:85.7%, Spec:78.4%, p < 0.001) are strong predictors for mortality. Conclusion: In this study, we showed that simple markers such as CAR, which augment the inflammation marker feature of CRP, and uric acid can give prognostic information in PAH patients.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.
