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    Demographics of patients with heart failure who were over 80 years old and were admitted to the cardiology clinics in Turkey
    (Turkish Soc Cardiology, 2019) Gok, Gulay; Zoghi, Mehdi; Sinan, Umit Yasar; Kilic, Salih; Tokgozoglu, Lale; Sumerkan, Mutlu Cagan; Emren, Volkan; Bekar, Lutfu; Cersit, Sinan; Tunc, Elif; Ulucan, Seref; Altuntas, Emine; Canpolat, Ugur; Ozmen, Namik; Aciksari, Gonul; Dogan, Nazile Bilgin; Gunay, Seyda; Kemaloglu, Meltem Didem; Nacar, Alper Bugra; Karakoyun, Suleyman; Inci, Sinan; Ozlek, Bulent; Aslan, Onur; Baykiz, Derya; Gunduz, Sabahattin; Koroglu, Sedat; Helvaci, Aysen; Coskun, Rasit; Yuksel, Isa Oner; Cetin, Sukru; Yesin, Mahmut; Gursoy, Mustafa Ozan; Enar, Sibel Catirli; Ozturk, Mujgan Tek; Yilmaz, Aykut; Basaran, Ozcan; Okyay, Kaan; Ozturk, Cengiz; Celik, Oguzhan; Yalcinkaya, Emre; Aslan, Vedat; Senol, Utku; Ucar, Fatih Mehmet; Kozluca, Volkan; Turkoglu, Ebru Ipek; Sekuri, Cevat; Erturk, Mehmet; Altun, Ibrahim; Belen, Erdal; Aksan, Gokhan; Yildirim, Erkan; Sayin, Ahmet; Akkoyun, Dursun Cayan; Tuncez, Abdullah; Dogan, Volkan; Gurel, Yusuf Emre; Demirelli, Selami; Koca, Cigdem; Biteker, Murat; Bas, Hasan Aydin; Guzet, Feza; Tacoy, Gulten; Alpsoy, Seref; Turan, Turhan; Davutoglu, Vedat; Birdane, Alparslan; Onrat, Ersel; Baha, Mehmet Resat; Yilmaz, Sabiye; Altay, Servet; Alici, Mehmet Hayri; Ozcan, Ismail Turkay; Kus, Gorkem; Demir, Gultekin Gunhan; Sancar, Kadriye Memic; Demircelik, Muhammed Bora; Yanik, Ahmet; Akciger, Atike Nazli; Hoscan, Yesim; Arslan, Kursat; Otlu, Yilmaz Omur; Sahin, Ismail; Ersoy, Ibrahim; Yilmaz, Dilek Cicek; Mert, Kadir Ugur; Varim, Perihan; Ari, Hatem
    Objective: Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. Methods: The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: >= 50%). Results: A total of 1098 patients (male, 47.5%; mean age, 83.5 +/- 3.1 years) aged 80 years and 4596 patients (male, 50.2 %; mean age, 71.1 +/- 4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were >= 80 years and 27.1% for patients 65-79 years old. For patients aged >= 80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p<0.01), whereas CAD had a higher prevalence in the HFrEF group (p=0.02). Among patients aged 65-79 years, 43.9% (548) had HFpEF, and 56.1% (700) had HFrEF. In this group of patients aged 65-79 years with HFrEF, the prevalence of DM was significantly higher than in patients aged >= 80 years with HFrEF (p<0.01). Conclusion: HF is common in elderly Turkish population, and its frequency increases significantly with age. Females, diabetics, and hypertensives are more likely to have HFpEF, whereas CAD patients are more likely to have HFrEF.
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    The rationale and design of the national peripartum cardiomyopathy registries in Turkey: the ARTEMIS-I and ARTEMIS-II studies
    (2018) Kayıkçıoğlu, Meral; Tokgozoglu, Lale; Mutluer, Ferit Onur; Ural, Dilek; Biteker, Murat
    Objective: Peripartum cardiomyopathy (PPCM) is left ventricular (LV) systolic dysfunction with an ejection fraction of ?45% occurring in the later stages of pregnancy or soon after delivery. Although various risk factors have been identified, the exact cause of the disease is unknown. Unlike most countries in the European region, Turkey has yet to determine the current PPCM burden. A registry for this purpose does not exist. To close this gap, the A RegisTry of pEripartuM cardIomyopathy in Turkish patientS (ARTEMIS-I and ARTEMIS-II), was planned and endorsed by the Turkish Society of Cardiology. the aim of this manuscript is to describe the rationale and design of the ARTEMIS-I and ARTEMIS-II registries. Methods:ARTEMIS was designed to be the nationwide PPCM registry of Turkey, with the goal of identifying problems and opportunities while improving quality and consistency in the medical care of PPCM patients. A second goal is to determine the clinical characteristics pertinent to patients in this region. the ARTEMIS registry will consist of 2 arms. All secondary and tertiary cardiology centers have been electronically invited to participate in ARTEMIS-I, which will be conducted to assess the current standard of care and outcome measures. Centers will be asked to enroll PPCM patients admitted to their clinic in last 5 years retrospectively. Eligibility criteria will consist of pregnant or early postpartum woman without a previous history of heart failure (HF) or known pathology associated with HF, LV ejection fraction ?45%, and exclusion of other causes of LV systolic dysfunction. ARTEMIS-II will consist of the prospective enrollment of patients. Conclusion: the nationwide PPCM registries, ARTEMIS-I and ARTEMIS-II, are designed to determine the current status of medical care, provide insights into nature of the disease, and suggest solutions on how to improve care and outcomes in these patients.
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    The rationale and design of the national peripartum cardiomyopathy registries in Turkey: The ARTEMIS-I and ARTEMIS-II studies
    (Turkish Soc Cardiology, 2018) Kayikcioglu, Meral; Tokgozoglu, Lale; Mutluer, Ferit Onur; Ural, Dilek; Biteker, Murat
    Objective: Peripartum cardiomyopathy (PPCM) is left ventricular (LV) systolic dysfunction with an ejection fraction of <= 45% occurring in the later stages of pregnancy or soon after delivery. Although various risk factors have been identified, the exact cause of the disease is unknown. Unlike most countries in the European region, Turkey has yet to determine the current PPCM burden. A registry for this purpose does not exist. To close this gap, the A RegisTry of pEripartuM cardIomyopathy in Turkish patientS (ARTEMIS-I and ARTEMIS-II), was planned and endorsed by the Turkish Society of Cardiology. The aim of this manuscript is to describe the rationale and design of the ARTEMIS-I and ARTEMIS-II registries. Methods: ARTEMIS was designed to be the nationwide PPCM registry of Turkey, with the goal of identifying problems and opportunities while improving quality and consistency in the medical care of PPCM patients. A second goal is to determine the clinical characteristics pertinent to patients in this region. The ARTEMIS registry will consist of 2 arms. All secondary and tertiary cardiology centers have been electronically invited to participate in ARTEMIS-I, which will be conducted to assess the current standard of care and outcome measures. Centers will be asked to enroll PPCM patients admitted to their clinic in last 5 years retrospectively. Eligibility criteria will consist of pregnant or early postpartum woman without a previous history of heart failure (HF) or known pathology associated with HF, LV ejection fraction <= 45%, and exclusion of other causes of LV systolic dysfunction. ARTEMIS-II will consist of the prospective enrollment of patients. Conclusion: The nationwide PPCM registries, ARTEMIS-I and ARTEMIS-II, are designed to determine the current status of medical care, provide insights into nature of the disease, and suggest solutions on how to improve care and outcomes in these patients.
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    Rationale, design, and methodology of the Evaluation of Perceptions, Knowledge, and Compliance with the Guidelines in Real Life Practice: A Survey on the Under-treatment of Hypercholesterolemia
    (Turkish Soc Cardiology, 2018) Dogan, Volkan; Basaran, Ozcan; Ozlek, Bulent; Celik, Oguzhan; Ozlek, Eda; Mert, Kadir Ugur; Rencuzogullari, Ibrahim; Mert, Gurbet Ozge; Dogan, Marwa Mouline; Biteker, Murat; Kayikcioglu, Meral
    Objective: A wide gap exists between dyslipidemia guidelines and their implementation in the real world, which is primarily attributed to physician and patient compliance. The aim of this study is to determine physician and patient adherence to dyslipidemia guidelines and various influential factors. Methods: The Evaluation of Perceptions, Knowledge, and Compliance with the Guidelines in Real Life Practice: A Survey on the Under-treatment of Hypercholesterolemia (EPHESUS) trial (ClinicalTrials. gov number NCT02608645) will be an observational, multicenter, non-interventional study. The study targets enrollment of 2000 patients from 50 locations across Turkey. All of the data will be collected in a single visit and current clinical practice will be evaluated. A cross-sectional survey of public perception and knowledge of cholesterol treatment among Turkish adults will be performed. All consecutive patients admitted to cardiology clinics who are in the secondary prevention group (coronary heart disease, peripheral artery disease, atherosclerotic cerebrovascular disease) and who are in the high-risk primary prevention group (type 2 diabetes mellitus with no prior known coronary heart disease; patients who had markedly elevated single risk factors, in particular, cholesterol >8 mmol/L [>310 mg/dL], blood pressure >= 180/110 mmHg, a calculated Systematic Coronary Risk Evaluation [SCORE] >= 5%, or <10% 10-year risk of fatal cardiovascular disease) will be included. Demographic, lifestyle, medical, and therapeutic data will be collected with a survey designed for the study. Conclusion: The EPHESUS registry will be the largest study conducted in Turkey evaluating the adherence to dyslipidemia guidelines both in secondary and high-risk primary prevention patients.
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    The reasons of poor lipid target attainment for secondary prevention in real life practice: Results from EPHESUS
    (Wiley, 2019) Mert, Gurbet Ozge; Basaran, Ozcan; Mert, Kadir Ugur; Dogan, Volkan; Ozlek, Buelent; Celik, Oguzhan; Ozlek, Eda; Cil, Cem; Ozdemir, Ibrahim Halil; Rencuzogullari, Ibrahim; Karadeniz, Fatma Ozpamuk; Bekar, Lutfu; Aktas, Muejdat; Resulzade, Mubariz Murat; Kalcik, Macit; Aksan, Gokhan; Cinier, Goksel; Akay, Kadriye; Pekel, Nihat; Senol, Utku; Biteker, Murat; Kayikcioglu, Meral
    Objective There are lack of studies considering the suboptimal management of dyslipidemia especially in cardiology outpatient clinics. This study was conducted to assess the patient adherence to cholesterol treatment recommendations and attainment of low-density-lipoprotein cholesterol (LDL-C) goals. Methods EPHESUS (NCT02608645) is a national, observational and multicenter registry which has been designed as a cross-sectional study to allow inclusion of all consecutive patients with hypercholesterolemia in cardiology outpatient clinics. The present subgroup analyses of the EPHESUS trial included patients with known peripheral artery disease or atherosclerotic cerebrovascular disease, and coronary heart disease namely secondary prevention. Results The present analysis of the EPHESUS study included 1482 patients (62.79 +/- 10.4 years, 38.2% female) with secondary prevention from 40 sites in Turkey. Regarding recommended lipid targets for LDL-C, only 267 patients (18%) were below the target of 70 mg/dL. Females were significantly more off-target when compared with male patients (396, 85.5% vs 67, 14.5%; P = 0.017). Moreover, the achievement of LDL-C goal was significantly decreased with illiteracy (233, 19.2% vs 35, 13.1%; P = 0.02). Patients who think that the cholesterol treatment should be terminated when the cholesterol level of a patient has normalised were higher in the off-target group (34.0% vs 24.7%, P < 0.001). Besides, physician perceptions about LDL-C goal for secondary prevention were significantly related with LDL-C target attainment. Conclusions EPHESUS is an important study with large population in terms of representing real-life practice of the adherence to dyslipidemia guidelines in secondary prevention patients in Turkey. Perceptions, knowledge, and compliance with the guidelines for secondary prevention have increased, but it is far below from the desired levels even in cardiology outpatient clinics. There is a need for patients' and physicians' education regarding the treatment of hyperlipidemia.