Browsing by Author "Kozan, Omer"

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Antithrombotic treatment pattern in newly diagnosed atrial fibrillation patients and 2-year follow-up results for dabigatran-treated patients in the Africa/Middle-East Region: Phase II results from the GLORIA-AF registry program
(2021) Azar, Rabih R.; Ragy, Hany; Kozan, Omer; El Khuri, Maurice; Bazergani, Nooshin; Marler, Sabrina; Teutsch, Christine; Ibrahim, Mohammed; Lip, Gregory Y. H.; Huisman, Menno; 33912651; ABC-9349-2021
Background: Data on the epidemiology and treatment of atrial fibrillation in the Africa/Middle East region are limited, and the use of novel oral anticoagulants and their effectiveness in real-world clinical practice has not been evaluated. Methods and Results: This study used prospectively collected data from the Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation (GLORIA-AF) to describe anticoagulant use and outcomes in Africa and the Middle East. Baseline characteristics of patients newly diagnosed with nonvalvular atrial fibrillation from Lebanon (242 patients, 40.3%), Saudi Arabia (236 patients, 39.3%), United Arab Emirates (87 patients, 14.5%), and South Africa (35 patients, 5.8%) were described, and clinical outcomes were investigated for all patients in this region who received dabigatran. In newly diagnosed patients (having a diagnosis within the last three months) with nonvalvular atrial fibrillation in Africa and the Middle East, the observed uptake of non-vitamin K oral anticoagulants was high in the first years following their availability; dabigatran was the most commonly used antithrombotic agent (314/600 patients), and only 1.5% of patients did not receive any antithrombotic therapy. Use of dabigatran was associated with a high persistence rate (>88% at 24 months) and low incidence rates of stroke, myocardial infarction, major bleeding, and all-cause mortality after 2 years of follow-up. Conclusions: Data from GLORIA-AF reveal a change in the landscape for stroke prevention in the AME region, and the results were consistent with those observed in the global GLORIA-AF registry, as well as those of randomized clinical trials. (C) 2021 The Authors. Published by Elsevier B.V.
Endocarditis-TR: Diagnosis, treatment, and prognosis of the infective endocarditispatients admitting tertiary centres of Turkey
(2022) Calik, Ali Nazmi; Ozluk, Fatma Ozlem Arican; Karatas, Mehmet Baran; Canga, Yigit; Eren, Semih; Ayhan, Gorkem; Sunbul, Ayse; Palice, Ali; Candemir, Aytac; Akyuz, Sukru; Zoghi, Mehdi; Kozan, Omer; 36161622
Background/aim: Infective endocarditis (IE) is still a significant cause of morbidity and mortality among cardiovascular diseases. ENDOCARDITIS-TR study aims to evaluate the compliance of the diagnostic and therapeutic methods being used in Turkey with current guidelines. Materials and methods: The ENDOCARDITIS-TR trial is a multicentre, prospective, observational study consisting of patients admitted to tertiary centres with a definite diagnose of IE. In addition to the demographic, clinical, microbiological, and echocardiographic findings of the patients, adverse events, indications for surgery, and in-hospital mortality were recorded during a 2-year time interval. Results: A total of 208 IE patients from 7 tertiary centres in Turkey were enrolled in the study. The study population included 125 (60.1%) native valve IE (NVE), 65 (31.3%) prosthetic IE (PVIE), and 18 (8.7%) intracardiac device-related IE (CDRIE). One hundred thirty-five patients (64.9%) were culture positive, and the most frequent pathogenic agent was methicillin-susceptible Staphylococcus aureus (MSSA) (18.3%). Among 155 (74.5%) patients with an indication for surgery, only 87 (56.1%) patients underwent surgery. The all-cause mortality rate was 29.3% in-hospital follow-up. Multivariable Cox regression analysis revealed that absence of surgery when indicated (HR: 3.29 95% CI: 0.93-11.64 p = 0.05), albumin level at admission (HR: 0.46 95% CI: 0.29-0.73 P < 0.01), abscess formation (HR: 2.11 95% CI: 1.01-4.38 p = 0.04) and systemic embolism (HR: 1.78 95% CI: 1.05-3.02 p = 0.03) were ascertained independent predictors of in-hospital all-cause mortality. Conclusion: The short-term results of the ENDOCARDITIS-TR trial showed the high frequency of staphylococcal IE, relatively high in-hospital mortality rates, shortage of surgical treatment despite guideline-based surgical indications and low usage of novel imaging techniques. The results of this study will provide a better insight to physicians in respect to their adherence to clinical practice guidelines.
NT-proBNP level in stage 3-4 chronic kidney disease and mortality in long-term follow-up: HAPPY study subgroup analysis
(2020) Simsek, Mustafa Aytek; Degertekin, Muzaffer; Cabbar, Ayca Turer; Hunuk, Burak; Akturk, Serkan; Erdogmus, Siyar; Mutlu, Bulent; Kozan, Omer; 32633264
Objective: This was an investigation of the relationship between the N-terminal pro-brain natriuretic peptide (NT-proBNP) level and mortality in patients with stage 3-4 chronic kidney disease (CKD). Methods: This study was designed as a subgroup analysis of the Heart Failure Prevalence and Predictors in Turkey (HAPPY) study. The HAPPY study included 4650 randomly selected individuals from the 7 geographical regions of Turkey. A total of 191 subjects from the original cohort with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.1.73 m(2) were enrolled in this study and the relationship between NT-proBNP and mortality was investigated. Prognostic variables for total and cardiovascular mortality were also examined using Cox regression analysis. Results: The mean length of follow-up was 76.12 +/- 22.45 months. The mean NT-proBNP level was 423.54 +/- 955.88 pg/mL. During follow-up, 51 subjects (26.7%) died from any cause and 36 subjects (18.8%) died from a cardiovascular cause. The presence of hypertension (hazard ratio [HR]: 1.89; 95% confidence interval [CI]: 1.01-3.50; p=0.048), anemia (HR: 2.49; 95% CI: 1.20-5.15; p=0.014), male gender (HR: 2.64; 95% CI: 1.44-4.86; p=0.002) and log NT-proBNP (HR: 4.93; 95% CI: 2.83-8.58; p<0.001) were independent variables for total mortality. The presence of hypertension (HR: 2.47; 95% CI: 1.09-5.56; p=0.029), male gender (HR: 2.79; 95% CI: 1.38-5.62; p=0.004), eGFR (HR: 0.94; 95% CI: 0.91-0.98; p=0.005) and log NT-proBNP (HR: 6.31; 95% CI: 3.11-12.81; p<0.001) were independent predictors of cardiovascular mortality. Conclusion: NT-proBNP was found to be an independent prognostic marker in patients with stage 3-4 CKD.
Predictors of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Complicated With Cardiogenic Shock
(2019) Hayiroglu, Mert Ilker; Keskin, Muhammed; Uzun, Ahmet Ozkan; Yildirim, Duygu Ilke; Kaya, Adnan; Cinier, Goksel; Bozbeyoglu, Emrah; Yildirimturk, Ozlem; Kozan, Omer; Pehlivanoglu, Seckin; 29191504
Background ST-segment elevation myocardial infarction (STEMI) complicated with cardiogenic shock (CS) remains as an unresolved condition causing high morbidity and mortality despite advances in medical treatment and coronary intervention procedures. In the current study, we evaluated the predictors of in-hospital mortality of STEMI complicated with CS. Methods In this retrospective study, we evaluated the predictive value of baseline characteristics, angiographic, echocardiographic and laboratory parameters on in-hospital mortality of 319 patients with STEMI complicated with CS who were treated with primary percutaneous coronary intervention. Patients were divided into two groups consisting of survivors and non-survivors during their index hospitalisation period. Results The mortality rate was found to be 61.3% in the study population. At multivariate analysis after adjustment for the parameters detected in univariate analysis, chronic renal failure, Thrombolysis In Myocardial Infarction (TIMI) post percutaneous coronary intervention (PCI) <= 2, plasma glucose and lactate level, blood urea nitrogen level, Tricuspid Annular Plane Systolic Excursion (TAPSE) and ejection fraction were independent predictors of in-hospital mortality. Conclusions Apart from haemodynamic deterioration, angiographic, echocardiographic and laboratory parameters have an impact on in-hospital mortality in patients with STEMI complicated with CS.
Resting Heart Rate and Real-Life Treatment Modalities in Outpatients with Left Ventricular Systolic Dysfunction Study: A Multicenter, Prospective, Observational, and National Registry
(2021) Cavusoglu, Yuksel; Kozan, Omer; Temizhan, Ahmet; Kucukoglu, Mehmet Serdar; 33960305; ABC-9349-2021
Objective: Heart rate (HR) reduction is associated with improved outcomes in heart failure (HF). This multicenter, prospective, observational, and national registry aimed to evaluate resting HR and the impacts of HR-related medications in real-life clinical practice in patients with HF. Methods: The Resting HR and Real-Life Treatment Modalities in Outpatients with Left Ventricular Systolic Dysfunction (REALITY HF) study enrolled 1054 patients with HF and left ventricular ejection fraction (LVEF) of <40% from 16 centers. Clinical characteristics, HR, and medications were noted (enrollment phase). A total of 487 patients with sinus rhythm and HR of >= 70 bpm were included in a further 4-month follow-up (FU) program (V0). Changes in HR and medications were reevaluated at 1-month (V1) and 4-month (V2) FU visits. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess the quality of life (QoL) of 320 patients in a 4-month FU program. Results: During enrollment, 794 patients (75.3%) were in sinus rhythm, in whom resting HR was 76.7 +/- 14 bpm, 69.1% had a resting HR of >= 70 bpm, 79.1% were receiving beta blocker (BB), and 6.1% were receiving ivabradine. Resting HR was lower in patients receiving BB (75.8 +/- 13 vs. 80.4 +/- 16 bpm; p=0.001); however, 65.8% of those still had a resting HR of >= 70 bpm. A significant association was found between elevated HR and worse New York Heart Association (NYHA) class, worse QoL, or lower LVEF. During the 4-month FU, adjustment of HR-lowering therapy was left to the physician's discretion. Resting HR significantly reduced from 83.6 +/- 12 (80) bpm at V0 to 78.6 +/- 13 (77) bpm at V1 (p=0.001) and further decreased to 73.0 +/- 11 (73) bpm at V2 (p=0.001). Patients achieving a resting HR of >= 70 bpm were 21.7% at V1 (p=0.001) and 39.9% at V2 (p=0.001). KCCQ significantly increased from 59.7 +/- 23 (62.7) at V0 to 73.1 +/- 18 (78.5) at V2 (p=0.001). In addition, patients with NYHA I increased from 22.2% at V0 to 29.2% at V1 and 39.4% at V2 (p=0.01). Conclusion: In real-life clinical practice, elevated HR is highly prevalent in HF despite widely used BB therapy and is associated with worse clinical picture. Therapeutic interventions targeting HR significantly reduce HR, and HR lowering is associated with improved clinical outcomes.
Validation of a Knowledge Test in Turkish Patients on Warfarin Therapy at an Ambulatory Anticoagulation Clinic
(2021) Turker, Meltem; Sancar, Mesut; Demirtunc, Refik; Ucar, Nazlican; Uzman, Osman; Ay, Pinar; Kozan, Omer; Okuyan, Betul; 34496551; ABC-9349-2021
Objectives: This study aimed to evaluate the validity and reliability of an oral anticoagulation knowledge (OAK) test in Turkish patients on warfarin therapy at an anticoagulant outpatient clinic. Materials and Methods: This study was conducted at an ambulatory anticoagulation clinic and included patients older than 18 years who had been using warfarin for at least six months. Patients' demographic and clinical data were collected. Internal consistency was calculated using the Kuder-Richardson 20 (KR-20) coefficient, and the test-retest reliability of the Turkish version of the OAK test was assessed. Results: Patients' mean age was 59.83 +/- 11.93 (26-90) years (n=240; 133 women). The mean score of the OAK test was 14.19 +/- 3.01. The test-retest reliability of the scale (n=30) was moderate for the total score (p<0.001). The KR-20 value, a measure of internal consistency, was 0.671. Patients of a younger age and higher educational level were more likely to have higher levels of anticoagulation knowledge than patients of an older age and lower education level (p<0.05 for both comparisons). Conclusion: The Turkish version of the OAK test can be used to determine the patients' knowledge on oral anticoagulation.