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Öğe Design and rationale for the ASSOS study: appropriateness of aspirin use in medical outpatients a multicenter and observational study(Turkish Society of Cardiology, 2018) Çelik, Oğuzhan; Çil, Cem; Özlek, Bülent; Özlek, Eda; Doğan, Volkan; Başaran, Özcan; Demirci, Erkan; Bekar, Lütfü; Kalçık, Macit; Karaarslan, Osman; Yetim, Mücahit; Doğan, Tolga; Demir, Vahit; Kalkan, Sedat; Özkan, Buğra; Hidayet, Şıho; Taylan, Gökhan; Küçüksu, Zafer; Çelik, Yunus; Efe, Süleyman Çağan; Aslan, Onur; Biteker, MuratObjective: The aim of this study was to describe the current status of aspirin use and the demographic characteristics of patients on aspirin for primary and secondary prevention of cardiovascular diseases. Methods: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) trial was a multicenter, cross-sectional, and observational study conducted in Turkey. The study was planned to include 5000 patients from 14 cities in Turkey. The data were collected at one visit, and the current clinical practice regarding aspirin use was evaluated (ClinicalTrials.gov number NCT03387384). Results: The study enrolled all consecutive patients who were admitted to the outpatient cardiology clinics from March 2018 until June 2018. Patients should be at least 18 years old, have signed written informed consent, and on aspirin (80–325 mg) therapy within the last 30 days. Cardiologists from the hospital participates in the study. Patients were divided into 2 categories according to presence or absence of atherosclerotic cardiovascular disease, namely secondary prevention group and primary prevention group, respectively. The appropriate use of aspirin in the primary and secondary prevention groups was assessed according to the European Society of Cardiology guidelines and US Preventive Services Task Force. The patients’ gastrointestinal bleeding risk factors and colorectal cancer risk were evaluated. Conclusion: The ASSOS registry will be the most comprehensive and largest study in Turkey evaluating the appropriateness of aspirin use. The results of this study help understand the potential misuse of aspirin in a real-world setting. © 2018 by Turkish Society of Cardiology.Öğe Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia(2019) Doğan, Volkan; Başaran, Özcan; Özlek, Bülent; Çelik, Oğuzhan; Özlek, Eda; Çil, Cem; Kayıkçıoğlu, MeralObjective: Few studies have directly assessed suboptimal management of dyslipidemia in Turkey. This study was conducted to assess patients’ understanding and perceptions of high cholesterol as well as physicians’ knowledge and awareness of lipid management strategies. Methods: This was a multicenter, observational study (ClinicalTrials.gov identifier: NCT02608645). Consecutive patients admitted to the participating cardiology clinics who were at least 18 years of age and who had been classified in a secondary prevention (SP) group or a high-risk primary prevention (PP) group were enrolled. The study population included 1868 patients from 40 sites in Turkey. Two-thirds (67.5%) of the patients in the SP group had been prescribed a statin, whereas only 30.1% of the PP group patients received statin therapy (p<0.001). Results: It was determined that 18% of the SP patients and 10.6% of the PP patients had a low-density lipoprotein cholesterol level at the recommended level (p<0.001). A patient survey revealed that almost half of the patients in the PP and in the SP groups were aware that their cholesterol levels were high. Negative information about statin treatment disseminated by media programs was the most common reason (9.4%) given for treatment discontinuation. Conclusion: Perceptions, knowledge and compliance with the guidelines for PP and SP patients in real-life practice have increased, but it remains far below the desired level. Patients and physicians should have more information about the treatment of hyperlipidemia. More accurate media programming could help to prevent the dissemination of misinformationÖğe 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) Başaran, Özcan; Doğan, Volkan; Mert, Kadir Uğur; Bekar, Lütfü; Kalçık, Macit; ...Background: The recent 2019 European Society of Cardiology/European Atherosclerosis Society practice guidelines introduced a new risk categorization for patients with diabetes. 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 estimated 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 according to previous and new guidelines. Results: This analysis included a total of 873 diabetic adults. Half of the study population (53.8%) were on lipid-lowering treatment and almost one-fifth (19.1%) were on highintensity 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 prevention patients, respectively. Conclusion: The control of dyslipidemia was extremely poor among patients with diabetes. 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 highdose 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.Öğe Misperceptions and management of LDL-cholesterol in secondary prevention of patients with familial hypercholesterolemia in cardiology practice: Real-life evidence from the EPHESUS registry(ELSEVIER SCIENCE INC, 2023) Kayıkçıoğlu, Meral; Başaran, Özcan; Doğan, Volkan; Bekar, Lütfü; Kalçık, MacitBACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is a common inherited disease, leading to premature atherosclerotic cardiovascular disease (ASCVD) due to elevated low-density lipoprotein cholesterol (LDL-C) levels. Achieving LDL-C goals is extremely important for preventing the complications of this fatal disease. We evaluated the management of FH patients with ASCVD in cardiology practice. METHODS: We analyzed patients with ASCVD from the nationwide EPHESUS registry, which was conducted in 40 cardiology outpatient clinics, and compared those with and without FH. RESULTS: Of the 1482 consecutively enrolled patients with ASCVD, 618 (41.7%) had FH, among which 455 were categorized as ’Possible FH’ and 163 as ’Probable or Definite FH’. Proposed LDL-C goals were not attained in more than 90% of the patients with FH. The proportion of those on statin therapy was 77% for possible and 91% for probable or definite FH, whereas 34.2 % and 59.4% were in use of high-intensity statins, respectively. None of the patients were on PCSK-9 inhibitors, and only 2 used ezetimibe. Adverse media coverage was the most common cause of statin discontinuation (32.5% in ’possible FH’ and 45.7% in ’probable/definite FH’). The negative impact of media in the decision to stop lipid lowering therapy (LLT) was increasing with education level. CONCLUSIONS: In real life most of the FH patients with ASCVD are undertreated in cardiology practice regarding statin dosing and combined LLT. Drug discontinuation rates are notably high and are mostly media-related, and side effects very rarely cause cessation of LLT. Urgent measures are needed to increase the awareness of FH among healthcare providers and patients and to develop improved treatment strategies aimed at preventing the complications of FH.Öğe Rationale, design, and methodology of the APOLLON trial: a comPrehensive, observational registry of heart failure with mid-range and preserved ejectioN fraction(Turkish Society of Cardiology, 2018) Özlek, Bülent; Özlek, Eda; Çelik, Oğuzhan; Çil, Cem; Doğan, Volkan; Tekinalp, Mehmet; Zencirkıran Ağuş, Hicaz; Kahraman, Serkan; Ösken, Altuğ; Rencüzoğulları, İbrahim; Tanık, Veysel Ozan; Bekar, Lütfü; Çakır, Mustafa Ozan; Kaya, Bedri Caner; Tibilli, Hakan; Çelik, Yunus; Başaran, Özcan; Mert, Kadir Uğur; Sevinç, Samet; Demirci, Erkan; Dondurmacı, Engin; Biteker, MuratObjective: Although almost half of chronic heart failure (HF) patients have mid-range (HFmrEF) and preserved left-ventricular ejection fraction (HFpEF), no studies have been carried out with these patients in our country. This study aims to determine the demographic characteristics and current status of the clinical background of HFmrEF and HFpEF patients in a multicenter trial. Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejectiON fraction (APOLLON) trial will be an observational, multicenter, and noninterventional study conducted in Turkey. The study population will include 1065 patients from 12 sites in Turkey. All data will be collected at one point in time and the current clinical practice will be evaluated (ClinicalTrials.gov number NCT03026114). Results: We will enroll all consecutive patients admitted to the cardiology clinics who were at least 18 years of age and had New York Heart Association class II, III, or IV HF, elevated brain natriuretic peptide levels within the last 30 days, and an left ventricular ejection fraction (LVEF) of at least 40%. Patients fulfilling the exclusion criteria will not be included in the study. Patients will be stratified into two categories according to LVEF: mid-range EF (HFmrEF, LVEF 40%-49%) and preserved EF (HFpEF, LVEF ?50%). Regional quota sampling will be performed to ensure that the sample was representative of the Turkish population. Demographic, lifestyle, medical, and therapeutic data will be collected by this specific survey. Conclusion: The APOLLON trial will be the largest and most comprehensive study in Turkey evaluating HF patients with a LVEF ?40% and will also be the first study to specifically analyze the recently designated HFmrEF category. © 2018 by Turkish Society of Cardiology.Öğe Rationale, design, and methodology of the EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study(2019) Özlek, Eda; Çekiç, Edip Güvenç; Özlek, Bülent; Çil, Cem; Çelik, Oğuzhan; Doğan, Volkan; Biteker, MuratObjective: The aim of this study is to assess the prevalence of polypharmacy, inappropriate drug use, and drug-drug interactions (DDIs) in elderly patients presenting at outpatient cardiology clinics in Turkey. Methods: The EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study will be an observational, real-world, multicenter study conducted to evaluate DDIs and polypharmacy in elderly cardiac outpatients. All consecutive patients (aged ?65 years) admitted to outpatient cardiology clinics between July 30, 2018 and July 30, 2019 who provide written, informed consent will be enrolled. A total of approximately 5000 patients are to be enrolled in this non-interventional study. All of the data will be collected at one point in time and current clinical practice will be evaluated (ClinicalTrials.gov NCT03370523). Results: Patient demographics, comorbid disease characteristics, laboratory test results, and details of medication use will be collected using self-reports and medical records. The severity of comorbid disease will be recorded and scored according to Charlson Comorbidity Index (CCI) and patients will be divided into 3 groups: mild, those with a CCI score of 1–2; moderate, those with a CCI score of 3–4; and severe, those with a CCI score of ?5. Polypharmacy will be defined as the use of 5 or more medications at one time. DDIs will be determined using the Lexicomp Online drug interaction screening tool and potentially inappropriate medications will be defined based on the 2015 update of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Severe drug interactions will be defined as those in category D or X. Conclusion: EPIC will be the first large-scale study in Turkey to evaluate polypharmacy, potentially inappropriate medications, and DDIs in elderly cardiac outpatients in a real-world clinical setting.Öğe Safety of once-or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: a NOAC-TR study(Association of Basic Medical Sciences of FBIH, 2018) Emren, Sadık Volkan; Zoghi, Mehdi; Berilgen, Rida; Özdemir, İbrahim Halil; Çelik, Oğuzhan; Çetin, Nurullah; Enhoş, Asım; Köseoğlu, Cemal; Akyüz, Abdurrahman; Doğan, Volkan; Levent, Fatih; Dereli, Yüksel; Doğan, Tolga; Başaran, Özcan; Karaca, Ilgın; Karaca, Özkan; Otlu, Yılmaz Ömür; Özmen, Çağlar; Coşar, Selvi; Sümerkan, Mutlu Çağan; Gürsul, Erdal; İnci, Sinan; Onrat, Ersel; Ergene, OktayOnce-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once-or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1:1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 ± 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23–2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3–20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04–5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications. © 2018 ABMSFBIH.
