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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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    How Did the Updated 2019 European Society of Cardiology/European Atherosclerosis Society Risk Categorization for Patients with Diabetes Affect the Risk Perception and Lipid Goals? A Simulated Analysis of Real-life Data from EPHESUS Study
    (Kare Publ, 2023) Basaran, Ozcan; Dogan, Volkan; Mert, Kadir Ugur; Ozlek, Bulent; Ozlek, Eda; Celik, Oguzhan; Cil, Cem
    Background: The recent 2019 European Society of Cardiology/European Atherosclerosis Society practice guidelines introduced a new risk categorization for patients with dia-betes. We aimed to compare the implications of the 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines with regard to the lipid-lowering treatment use, low-density lipoprotein cholesterol goal attainment rates, and the esti-mated proportion of patients who would be at goal in an ideal setting. Methods: Patients with diabetes were classified into 4 risk categories according to 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidemia guidelines from the database of EPHESUS (cross-sectional, observational, countrywide registry of cardiology outpatient clinics) study. The use of lipid-lowering treatment and low-density lipoprotein cholesterol goal attainment rates were then compared accord-ing to previous and new guidelines.Results: This analysis included a total of 873 diabetic adults. Half of the study popula-tion (53.8%) were on lipid-lowering treatment and almost one-fifth (19.1%) were on high -intensity statins. While low-density lipoprotein cholesterol goal was achieved in 19.5% and 7.5% of patients, 87.4% and 69.6% would be on target if their lipid-lowering treatment was intensified according to 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society lipid guidelines, respectively. The new target <55 mg/dL could only be achieved in 2.2% and 8.1% of very high-risk primary prevention and secondary pre-vention patients, respectively.Conclusion: The control of dyslipidemia was extremely poor among patients with diabe-tes. The use of lipid-lowering treatment was not at the desired level, and high-intensity lipid-lowering treatment use was even lower. Our simulation model showed that the high -dose statin plus ezetimibe therapy would improve goal attainment; however, it would not be possible to get goals with this treatment in more than one-third of the patients.
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    THE INVESTIGATION OF KINESIOPHOBIA , PAIN CATASTROPHIZING, PHYSICAL ACTIVITY, ANXIETY, AND DEPRESSION IN PATIENTS WITH OR WITHOUT MYOCARDIAL INFARCTION
    (Dokuz Eylul Univ Inst Health Sciences, 2023) Ozden, Fatih; Ozkeskin, Mehmet; Tumturk, Ismet; Ozlek, Eda; Ozlek, Bulent
    Purpose: The study aimed to investigate kinesiophobia, pain catastrophizing, physical activity, anxiety, and depression in patients with MI.Material and Methods: A cross-sectional study was conducted with 100 participants (50 myocardial infarction, 50 age-sex matched controls). Participants were evaluated with the Tampa Scale of Kinesiophobia for Heart (TSK Heart), Pain Catastrophizing Scale (PCS), International Physical Activity Questionnaire-Short Form (IPAQ-SF), and Hospital Anxiety and Depression Scale (HAD).Results: IPAQ-SF (except sitting time) was higher in the control group (p<0.01). PCS score (p<0.01), HAD-A (p=0.001) and HAD-D (p=0.006) scores were significantly higher in the MI group. TSK Heart was correlated with Sitting PA (r=0.425), Walking PA (r=-0.574), Moderate PA (r=-0.632), HAD-A (r=0.641) and HAD-D (r=0.827) (p<0.01). There was a relationship between HAD-A with Sitting PA, Walking PA and Moderate PA (r1=0.445, r2=-0.485, r3=-0.378, p<0.01). Lastly, HAD-D was correlated with Sitting PA, Walking PA and Moderate PA (r1=0.475, r2=-0.520, r3=-0.578, p<0.01).Conclusion: The study results showed decreased physical activity, increased kinesiophobia, pain catastrophizing, depression and anxiety in patients with MI. In addition, kinesiophobia was related to mild -moderate physical activity and depression-anxiety.
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    Management of LDL-cholesterol levels in patients with Diabetes Mellitus in Cardiology Practice: Real-life evidence of Under-treatment from the EPHESUS registry
    (Wiley, 2021) Mert, Kadir Ugur; Basaran, Ozcan; Mert, Gurbet Ozge; Dogan, Volkan; Rencuzogullari, Ibrahim; Ozlek, Bulent; Ozdemir, Ibrahim Halil
    Background and aims Effective treatment of high low-density lipoprotein cholesterol (LDL-C) levels has been shown to improve cardiovascular outcomes of patients with diabetes mellitus (DM). Herein, we aimed to provide insight to the real-life management of patients with DM in terms of LDL-C goal attainment and adherence to lipid management recommendations. Our objective was also to reveal the reasons of poor LDL-C goal attainment by assessing the perceptions of both physicians and patients. Methods We compared the diabetic and non-diabetic patients from the database of a nationwide registry conducted in cardiology outpatient clinics with regard to the demographic characteristics, educational status, comorbidities, medications, laboratory parameters and LDL-C goal attainment. Also, both the patients and attending physicians were surveyed to analyse perceptions and awareness of hypercholesterolemia. Results of the 1868 consecutively enrolled patients, 873 (47%) had DM. Proportion of patients on statins was significantly lower in patients with DM (67.8% vs 55.3%; P < .001). The proportion of patients who attained LDL-C targets were lower among the diabetic patients (17.8% vs 15%; P = .06). The most common causes of the discontinuation of statin therapy were negative media coverage about statins (32.1%), and recommendations of physicians to stop the lipid lowering therapy (29.6%). Analysis of the physician survey revealed that the physicians could determine the off-target patients accurately (negative predictive value 98.4%) while the positive predictive value (48.8%) was low. The reasons for not attaining the LDL-C goals in diabetic patients were not prescription of statins (38%) and inadequate (eg low-dose, non-adherent) statin (28.3%) dosages. Conclusions in real-life clinical cardiology practice, diabetic patients are far below the recommended LDL-C treatment goals. High-intensity statin treatment in diabetic population is still avoided because of the concerns about polypharmacy and drug interactions. Also, the inertia of physicians and even cardiologists is probably a major cause of refraining of prescription of optimal statin dosages.
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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.