Browsing by Author "Sinan, Umit Yasar"

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Clinical characteristics and in-hospital outcomes of acute decompensated heart failure patients with and without atrial fibrillation
(2020) Kocabas, Umut; Sinan, Umit Yasar; Arugaslan, Emre; Kursun, Mustafa; Coner, Ali; Celebi, Ozlem Ozcan; Ozturk, Cengiz; Dalgic, Onur; Turkoglu, Ebru Ipek; Kemal, Hatice Soner; Gazi, Emine; Altin, Cihan; Zoghi, Mehdi; 32352420
Objective: Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases. The impact of AF on in-hospital outcomes in acute decompensated heart failure (ADHF) is controversial. The aim of this study is to determine the prevalence of AF among hospitalized patients with ADHF and describe the clinical characteristics and in-hospital outcomes of these patients with and without AF. Methods: We examined the multicenter, observational data from the real-life data of hospitalized patients with HF: Journey HF-TR study in Turkey that studied the clinical characteristics and in-hospital outcomes of hospitalized patients with ADHF between September 2015 and September 2016. Results: Of the 1,606 patients hospitalized with ADHF, 626 (39%) had a history of AF or developed new-onset AF during hospitalization. The patients with AF were older (71 +/- 12 vs. 65 +/- 13 years; p<0.001) and more likely to have a history of hypertension, valvular heart disease, and stroke. The AF patients were less likely to have coronary artery disease and diabetes. In-hospital adverse event rates and length of in-hospital stay were similar in ADHF patients, both with and without AF. In-hospital all-cause mortality rate was higher in patients with AF than in patients without AF, although the difference was not statistically significant (8.9% vs. 6.8%; p=0.121). Conclusion: AF has been found in more than one-third of the patients hospitalized with ADHF, and it has varied clinical features and comorbidities. The presence of AF is not associated with increased adverse events or all-cause mortality during the hospitalization time.
Gender-related clinical and management differences in patients with chronic heart failure with reduced ejection fraction
(2020) Kocabas, Umut; Kivrak, Tarik; Yilmaz Oztekin, Gulsum Meral; Tanik, Veysel O.; Ozdemir, Ibrahim; Kaya, Ersin; Yuce, Elif Ilkay; Avci Demir, Fulya; Dogdus, Mustafa; Altinsoy, Meltem; Ustundag, Songul; Ozyurtlu, Ferhat; Karagoz, Ugur; Karakus, Alper; Urgun, Orsan Deniz; Sinan, Umit Yasar; Mutlu, Inan; Sen, Taner; Astarcioglu, Mehmet Ali; Kinik, Mustafa; Ozden Tok, Ozge; Uygur, Begum; Yeni, Mehtap; Alan, Bahadir; Dalgic, Onur; Altay, Hakan; Pehlivanoglu, Seckin; 33063424; AAE-1392-2021
Aim Gender-related differences have been described in the clinical characteristics and management of patients with chronic heart failure with reduced ejection fraction (HFrEF). However, published data are conflictive in this regard. Methods We investigated differences in clinical and management variables between male and female patients from the ATA study, a prospective, multicentre, observational study that included 1462 outpatients with chronic HFrEF between January and June 2019. Results Study population was predominantly male (70.1%). In comparison to men, women with chronic HFrEF were older (66 +/- 11 years vs 69 +/- 12 years, P < .001), suffered more hospitalisations and presented more frequently with NYHA class III or IV symptoms. Ischaemic heart disease was more frequent in men, whereas anaemia, thyroid disease and depression were more frequent in women. No difference was seen between genders in the use rate of renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or ivabradine, or in the proportion of patients achieving target doses of these drugs. Regarding device therapies, men were more often treated with an implantable cardioverter-defibrillator (ICD) and women received more cardiac resynchronisation therapy. Conclusion In summary, although management seemed to be equivalent between genders, women tended to present with more symptoms, require hospitalisation more frequently and have different comorbidities than men. These results highlight the importance of gender-related differences in HFrEF and call for further research to clarify the causes of these disparities. Gender-specific recommendations should be included in future guidelines in HFrEF.
Prognostic Significance of Medical Therapy in Patients with Heart Failure with Reduced Ejection Fraction
(2023) Kocabas, Umut; Ergin, Isil; Kivrak, Tarik; Oztekin, Gulsum Meral Yilmaz; Tanik, Veysel Ozan; Ozdemir, Ibrahim; Demir, Fulya Avci; Dogdus, Mustafa; Sen, Taner; Altinsoy, Meltem; Ustundag, Songul; Urgun, Orsan Deniz; Sinan, Umit Yasar; Uygur, Begum; Yeni, Mehtap; Ozcalik, Emre; 0000-0001-6424-9399; 37804042; GXG-7709-2022
Aims The use of guideline-directed medical therapy (GDMT) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains suboptimal. The SMYRNA study aims to identify the clinical factors for the non-use of GDMT and to determine the prognostic significance of GDMT in patients with HFrEF in a real-life setting.Methods and results The SMYRNA study is a prospective, multicentre, and observational study that included outpatients with HFrEF. Patients were divided into three groups according to the status of GDMT at the time of enrolment: (i) patients receiving all classes of HF medications including renin-angiotensin system (RAS) inhibitors, beta-blockers, and mineralocorticoid receptor antagonists (MRAs); (ii) patients receiving any two classes of HF medications (RAS inhibitors and beta-blockers, or RAS inhibitors and MRAs, or beta-blockers and MRAs); and (iii) either patients receiving class of HF medications (only one therapy) or patients not receiving any class of HF medications. The primary outcome was a composite of hospitalization for HF or cardiovascular death. The study population consisted of 1062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (range: 20-96) years. RAS inhibitors, beta-blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1% of the patients, respectively. The proportions of patients receiving target doses of guideline-directed medications were 24.4% for RAS inhibitors, 11.0% for beta-blockers, and 11.1% for MRAs. Overall, 491 patients (46.2%) were treated with triple therapy, 353 patients (33.2%) were treated with any two classes of HF medications, and 218 patients (20.6%) were receiving only one class of HF medication or not receiving any HF medication. Patient-related factors comprising older age, New York Heart Association functional class, rural living, presence of hypertension, and history of myocardial infarction were independently associated with the use or non-use of GDMT. During the median 24-month period, the primary composite endpoint occurred in 362 patients (34.1%), and 177 of 1062 (16.7%) patients died. Patients treated with two or three classes of HF medications had a decreased risk of hospitalization for HF or cardiovascular death compared with those patients receiving <= 1 class of HF medication [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.49-0.85; P = 0.002, and HR: 0.61; 95% CI: 0.47-0.79; P < 0.001, respectively].Conclusions The real-life SMYRNA study provided comprehensive data about the clinical factors associated with the non-use of GDMT and showed that suboptimal GDMT is associated with an increased risk of hospitalization for HF or cardiovascular death in patients with HFrEF.
Real-Life Data of Major and Minor Bleeding Events with Direct Oral Anticoagulants in the One-Year Follow-Up Period: The NOAC-TURK Study
(2021) Gedikli, Omer; Altay, Servet; Unlu, Serkan; Cakmak, Huseyin Altug; Askin, Lutfu; Yanik, Ahmet; Besli, Feyzullah; Sinan, Umit Yasar; Canpolat, Ugur; Sahin, Mahmut; Pehlivanoglu, Seckin; 33690135; ABC-9264-2021
Objective: This study aimed to evaluate the safety of direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF) during daily clinical practice. Methods: This was a prospective study conducted between January 01, 2016, and April 01, 2017, in patients aged >= 18 years with a diagnosis of NVAF. We performed the study in 9 clinical centers from different regions of Turkey, and the mean follow-up period was 12+2 months. We investigated major and minor bleeding events of DOAC. Results: A total of 1807 patients with NVAF were enrolled. The mean age of the patients was 73.6 +/- 10.2 years, CHA2DS2-VASc score was 3.6 +/- 1.4, and HAS-BLED score was 2 +/- 1.2. The most frequently prescribed DOAC was dabigatran 110 mg bid in 409 (22.6%) patients. The patients on apixaban 2.5 mg bid were older (p<0.001). Patients on rivaroxaban 15 mg od also had a higher prevalence of chronic renal failure, 46 (16.7%) patients. A total of 205 (11.4%) bleeding events were observed; among these, 34 (1.9%) patients had major bleeding and 171 (9.4%) patients had minor bleeding. The major and minor bleeding events were 2/273 (0.7%) and 30/273 (10.9%) in patients receiving dabigatran 150 mg bid, 13/409 (3%) and 44/409 (10.7%) in patients receiving dabigatran 110 mg bid, 4/385 (1%) and 42/385 (10.9%) in patients receiving rivaroxaban 20 mg od, 8/276 (2.9%) and 27/276 (9.7%) in patients receiving rivaroxaban 15 mg od, 3/308 (0.9%) and 14/308 (4.5%) in patients receiving apixaban 5 mg bid, 4/156 (2.5%) and 14/156 (9%) in patients receiving apixaban 2.5 mg bid, respectively. The total bleeding events were 17 (5.6%) in patients receiving apixaban 5 mg, less than those receiving other DOACs. On multivariate analyses, rivaroxaban 20 mg od (p=0.002), ATRIA and HAS-BLED scores, and peripheral artery disease were independent indicators of bleeding. The most frequent location of major bleeding was the gastrointestinal system (GIS) [17 (0.9%) patients], and the most frequent location of minor bleeding was the gingiva [45 (2.5%) patients]. Conclusion: This study showed that similar results as the previous real-life study; however, we had some different results, such as the GIS tract bleeding was more frequent in patients receiving dabigatran 110 mg bid. The major and intracranial bleeding events were similar for different DOACs; and among DOACs, only rivaroxaban 20 mg od was associated with a high risk of bleeding.
Real-World Data on the Incidence of Stroke, Myocardial Infarction, and Mortality Among Nonvalvular Atrial Fibrillation Patients in Türkiye: New Oral Anticoagulants-TURKey Study
(2023) Unlu, Serkan; Altay, Servet; Gedikli, Omer; Ozden, Ozge; Canpolat, Ugur; Askin, Lutfu; Yayla, Cagri; Yanik, Ahmet; Cakmak, Huseyin Altug; Sinan, Umit Yasar; Besli, Feyzullah; Sahin, Mahmut; Pehlivanoglu, Seckin; 0000-0002-4837-7099; 37888785; A-7003-2017
Background: Atrial fibrillation (AF) is strongly associated with an increased risk of isch- emic events. Anticoagulation focuses on reducing the risk of embolism. Guideline recom- mended CHA2DS2-VASc scoring system is most widely used; however, different scoring systems do exist. Thus, we sought to assess the impact of anticoagulant treatment and different scoring systems on the development of stroke, myocardial infarction, and allcause mortality in patients with nonvalvular AF. Methods: The present study was designed as a prospective cohort study. The enrollment of the patients was conducted between August 1, 2015, and January 1, 2016. The followup period was defined as the time from enrollment to the end of April 1, 2017, which also provided at least 12 months of prospective follow-up for each patient. Results: A total of 1807 patients with AF were enrolled. During the follow-up, 2.7% (48) of patients had stroke, 0.8% (14) had myocardial infarction, and 7.5% (136) died. The antico- agulation and risk factors in AF (ATRIA) score had a better accuracy for the prediction of stroke compared to other scoring systems (0.729, 95% CI, 0.708-0.750, P < .05). Patients under low -dose rivaroxaban treatment had significantly worse survival (logrankP < .001). Age, CHA2DS2-VASc score, R2CHADS2 score, ATRIA score, chronic heart failure, prior stroke, and being under low -dose rivaroxaban treatment were independent predictors of clinical endpoint (P < .001). Conclusion: Low -dose rivaroxaban treatment was independently and strongly associated with the combined clinical endpoint. Furthermore, the ATRIA score proved to be a stronger predictor of stroke in the Turkish population.