Browsing by Author "Yilmaz, Mehmet Birhan"

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Cost-of-disease of Heart Failure in Turkey: A Delphi Panel-based Analysis of Direct and Indirect Costs
(2022) Cavusoglu, Yuksel; Altay, Hakan; Aras, Dursun; Celik, Ahmet; Ertas, Fatih Sinan; Kilicaslan, Baris; Nalbantgil, Sanem; Temizhan, Ahmet; Ural, Dilek; Yildirimturk, Ozlem; Yilmaz, Mehmet Birhan; 35872647
Background: Heart failure (HF) is considered a significant public health issue with a substantial and growing epidemiologic and economic burden in relation to longer life expectancy and aging global population Aims: To determine cost-of-disease of heart failure (HF) in Turkey from the payer perspective. Study Design: Cross-sectional cost of disease study. Methods: In this cost-of-disease study, annual direct and indirect costs of management of HF were determined based on epidemiological, clinical and lost productivity inputs provided by a Delphi panel consisted of 11 experts in HF with respect to ejection fraction (EF) status (HF patients with reduced EF (HFrEF), mid-range EF (HFmrEF) and preserved EF (HFpEF)) and New York Heart Association (NYHA) classification. Direct medical costs included cost items on outpatient management, inpatient management, medications, and non -pharmaceutical treatments. Indirect cost was calculated based on the lost productivity due to absenteeism and presenteeism. Results: 51.4%, 19.5%, and 29.1% of the patients were estimated to be HFrEF, HFmrEF, and HFpEF patients, respectively. The total annual direct medical cost per patient was $887 and non-pharmaceutical treatments ($373, 42.1%) were the major direct cost driver. Since an estimated nationwide number of HF patients is 1,128,000 in 2021, the total annual national economic burden of HF is estimated to be $1 billion in 2021. The direct medical cost was higher in patients with HFrEF than in those with HFmrEF or HFpEF ($1,147 vs. $555 and $649, respectively). Average indirect cost per patient was calculated to be $3,386 and was similar across HFrEF, HFmrEF and HFpEF groups, but increased with advanced NYHA stage. Conclusion: Our findings confirm the substantial economic burden of HF in terms of both direct and indirect costs and indicate that the non-pharmaceutical cost is the major direct medical cost driver in HF management, regardless of the EF status of HF patients.
Future of Advanced Heart Failure and Mechanical Support Devices: A Cardiology-Cardiovascular Surgery Consensus Report
(2016) Yilmaz, Mehmet Birhan; Akar, Ahmet Ruchan; Ekmekci, Ahmet; Nalbantgil, Sanem; Sade, Elif; Eren, Mehmet; Orhan, Gokcen; Ozbaran, Mustafa; Yagdi, Tahir; Kucuker, Seref Alp; Gurbuz, Ali; Tokgozoglu, Lale; https://orcid.org/0000-0003-3737-8595; 27111324; AAQ-7583-2021
Heart failure is a progressive disease. A considerable number of patients eventually reach an advanced or terminal phase, in spite of developments in diagnostic procedure, alternative treatments that can slow progression, management, and follow-up. In addition to palliative care of patients in the terminal phase, accurate recognition of advanced disease is vital in the determination of therapeutic options. Overall management of patients with heart failure requires the collaboration of professionals from multiple disciplines. Still, patients with advanced heart failure should be managed by a "heart team," as indicated by guidelines; communication and collaboration among cardiologists, cardiovascular surgeons, and other medical staff responsible for patient care is necessary. While our country has physicians experienced in the management of patients with advanced heart failure, these professionals are not distributed evenly across the country, and equitable access to therapeutic options is not provided. Hence, progress has yet to be made regarding appropriate referrals and patient circulation. The aims of the present consensus report are to strengthen the connection between certified, experienced centers and those that care for patients irrespective of disease phase and healthcare staff, as well as to raise awareness and provide information regarding conditions in Turkey.
Heart failure with non-reduced ejection fraction: Epidemiology, pathophysiology, phenotypes, diagnosis and treatment approaches
(2022) Cavusoglu, Yuksel; Celik, Ahmet; Altay, Hakan; Nalban, Sanem; Ozden, Ozge; Temizhan, Ahmet; Ural, Ditek; Unlu, Serkan; Yilmaz, Mehmet Birhan; Zoghi, Mehdi; 35969235
Heart failure (HF) has been classified as reduced ejection fraction (HFrEF), mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) by the recent HF guidelines. In addition, HF with improved ejection fraction has been defined as a subgroup of HFrEF. In HFrEF, diagnostic workup and evidence-based pharmacological and device-based therapies have been well established. However, HFpEF, which comprises almost half of the HF population, represents significant uncertainties regarding its pathophysiology, clinical phenotypes, diagnosis and treatment. Diagnostic criteria of HFpEF have been changed a few times over the years and still remained a matter of debate. New paradigms including a prominent role of co-morbidities. inflammation, endothelial dysfunction have been proposed in its pathophysiology. As a complex, multifactorial syndrome HFpEF consists of many overlapping clinical and hemodynamic phenotypes. In contrast to HFrEF, clinical outcomes of HFpEF have not improved over the last decades due to lack of proven effective therapies. Although HFrEF and HFpEF have different clinical spectrums and proposed pathophysiological mechanisms, there is no clear defining syndrome postulated for HFmrEF. Clinical characteristics and risk factors of HFmrEF overlap with HFrEF and HFpEF. HFmrEF is also referred as a transitional zone for dynamic temporal changes in EF. So. HFpEF and HFmrEF, both namely HF with non-reduced ejection fraction (HF-NEF), have some challenges in the management of HF. The purpose of this paper is to provide a comprehensive review including epidemiology, pathophysiology, clinical presentation and phenotypes of HF-NEF and to guide clinicians for the diagnosis and therapeutic approaches based on the available data in the literature.
Increased frequency of occurrence of bendopnea is associated with poor outcomes in heart failure outpatients
(2020) Kaya, Hakki; Sahin, Anil; Gunes, Hakan; Bekar, Lutfu; Celik, Ahmet; Cavusoglu, Yuksel; Caldir, Vedat; Gungor, Hasan; Yilmaz, Mehmet Birhan; 32812491
Background Relationship between the frequency of occurrence of bendopnea during the daily life of heart failure (HF) outpatients and clinical outcomes has never been evaluated before. Methods Turkish Research Team-Heart Failure (TREAT-HF) is a network between HF centres, which undertakes multicentric observational studies in HF. Herein, the data including stable 573 HF patients with reduced ejection fraction out of seven HF centres were presented. A questionnaire was filled by the patients, with the question 'Do you experience shortness of breath while tying your shoelace?', assessing the presence and frequency of bendopnea. Results To the question related to bendopnea, 48% of the patients answered 'yes, every time', 31% answered 'yes, sometimes', and 21% answered 'No'. Patients were followed for an average of 24 +/- 14 months, and the patients who answered 'yes, every time' and 'yes, sometimes' to the bendopnea question were found having increased risk for both HF-related hospitalisations (HR:3.2,p < .001- HR:2.8,p = .005) and composite outcome consisting of 'HF-related hospitalisations and all-cause death in the multi-variate analysis (HR:3.1,p < .001- HR:3.0,p < .001). Kaplan Meier analysis for HF-related hospitalisation, all-cause death, and the composite of these were provided for these three groups, yielding significant and graded divergence curves with the best prognosis in 'no' group, with the moderate prognosis in 'sometimes' group, and with the worst prognosis in the 'every time' group. Conclusion For the first time in the literature, our study shows that the increased frequency of bendopnea occurrence in daily life is associated with poor outcomes in HF outpatients.
Iron deficiency and anemia in heart failure
(2017) Altay, Hakan; Cavusoglu, Yuksel; Cetiner, Mustafa; Guvenc, Tolga Sinan; Temizhan, Ahmet; Ural, Dilek; Yesibursa, Dilek; Yildirim, Nesligul; Yilmaz, Mehmet Birhan; 28446734; AAE-1392-2021
Heart failure is an important community health problem. Prevalence and incidence of heart failure have continued to rise over the years. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. Co-morbidities in heart failure have negative impact on clinical course of the disease, further impair prognosis, and add difficulties to treatment of clinical picture. Therefore, successful management of co-morbidities is strongly recommended in addition to conventional therapy for heart failure. One of the most common co-morbidities in heart failure is presence of iron deficiency and anemia. Current evidence suggests that iron deficiency and anemia are more prevalent in patients with heart failure and reduced ejection fraction, as well as those with heart failure and preserved ejection fraction. Moreover, iron deficiency and anemia are referred to as independent predictors for poor prognosis in heart failure. There is strong relationship between iron deficiency or anemia and severity of clinical status of heart failure. Over the last two decades, many clinical investigations have been conducted on clinical effectiveness of treatment of iron deficiency or anemia with oral iron, intravenous iron, and erythropoietin therapies. Studies with oral iron and erythropoietin therapies did not provide any clinical benefit and, in fact, these therapies have been shown to be associated with increase in adverse clinical outcomes. However, clinical trials in patients with iron deficiency in the presence or absence of anemia have demonstrated considerable clinical benefits of intravenous iron therapy, and based on these positive outcomes, iron deficiency has become target of therapy in management of heart failure. The present report assesses current approaches to iron deficiency and anemia in heart failure in light of recent evidence.
Management of Hyperkalemia in Heart Failure
(2021) Altay, Hakan; Cavusoglu, Yuksel; Celik, Ahmet; Demir, Serafettin; Kilicarslan, Baris; Nalbantgil, Sanem; Temizhan, Ahmet; Tokgoz, Bulent; Ural, Dilek; Yesilbursa, Dilek; Yildirimturk, Ozlem; Yilmaz, Mehmet Birhan; 34738907
Hyperkalemia is a common electrolyte abnormality in heart failure (HF) that can cause potentially life-threatening cardiac arrhythmias and sudden cardiac death. HF patients with diabetes, chronic kidney disease and older age are at higher risk of hyperkalemia. Moreover, hyperkalemia is also often associated with the use of renin-angiotensin-aldosterone system inhibitors (RAASi) including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists and sacubitril-valsartan. In clinical practice, the occurrence of hyperkalemia is a major concern among the clinicians and often limits RAASi use and/ or lead to dose reduction or discontinuation, thereby reducing their potential benefits for HF. Furthermore, recurrent hyperkalemia is frequent in the long-term and is associated with an increase in hyperkalemia-related hospitalizations. Therefore, management of hyperkalemia has a special importance in HF patients. However, treatment options in chronic management are currently limited. Dietary restriction of potassium is usually ineffective with variable adherence. Sodium polystyrene sulfonate is commonly used, but its effectiveness is uncertain and reported to be associated with intestinal toxicity. New therapeutic options such as potassium binders have been suggested as potentially beneficial agents in the management of hyperkalemia. This document discusses prevalence, predictors and management of hyperkalemia in HF, emphasizing the importance of careful patient selection for medical treatment, uptitration of the doses of RAASi, regular surveillance of potassium and treatment options of hyperkalemia.
Natriuretic Peptides in Clinical Practice
(2019) Cavusoglu, Yüksel; Alper, Ahmet Taha; Altay, Hakan; Celik, Ahmet; Demirkan, Burcu; Guvenc, Tolga Sinan; Kucukoglu, Mehmet Serdar; Nalbantgil, Sanem; Ozdemir, Murat; Ozin, Bulent; Sayin, Tamer; Yildirimturk, Ozlem; Yilmaz, Mehmet Birhan; Zorkun, Cafer; 30860204; AAE-1392-2021; AAD-9938-2021
Natriuretic peptides have long been introduced into clinical practice. These biomarkers have certainly been shown to provide useful information in the diagnosis, prognosis and risk stratification in heart failure and also may have a role in the guidance of heart failure therapy. Although, there are some limitations in using of these markers such as lack of specificity, aging, renal dysfunction or obesity, among the huge number of candidates for heart failure biomarkers, only natriuretic peptides are currently widely used in daily clinical practice in heart failure. Recent heart failure guidelines recognize natriuretic peptides as an essential tool in the new diagnostic and therapeutic algorithms. Furthermore, natriuretic peptides are not only used in the diagnosis or prognosis of heart failure, but also these biomarkers are referred to have some potential role in primary prevention, cardio-oncology, advanced heart failure, assessment of response to cardiac resynchronization therapy, pulmonary arterial hypertension, acute coronary syndromes, atrial fibrillation and valvular heart disease. In this article, natriuretic peptides have been reviewed for their updated information and new recommendations in heart failure and also potential role of these biomarkers in the management of various clinical conditions have been addressed in the form of expert opinion based on the available data in the literature.
Plasma Osmolality Predicts Mortality in Patients with Heart Failure with Reduced Ejection Fraction
(2014) Yilmaz, Mehmet Birhan; Ekmekci, A.; Gunes, H.; Uslu, A. U.; Beton, O.; Yucel, H.; Oguz, D.; Eren, M.
Pre-Discharge and Post-Discharge Management and Treatment Optimization in Acute Heart Failure
(2022) Cavusoglu, Yuksel; Altay, Hakan; Nalbantgil, Sanem; Temizhan, Ahmet; Yilmaz, Mehmet Birhan; 35860891
Acute heart failure is associated with high mortality and rehospitalization rates and required urgent evaluation and early initiation or intensification of therapy. The risk of death and heart failure rehospitalization is greatest in the early post-discharge period, particularly within the first 3-6 months, and declines over time, which is referred as a vulnerable period of acute heart failure hospitalization. Therefore, implementation of guidelines-directed optimal therapy is not only so crucial in the acute phase but also very important in the pre-discharge and early post-discharge period in reducing mortality and rehospitalization rates. The pre-discharge period represents a window of opportunity for treatment optimization which includes to eliminate congestion, to treat comorbidities or precipitating factors, and to initiate or uptitrate oral therapy before discharge. Early assessment in the post-discharge period based on clinical evaluation and laboratory exams, further optimization of disease-modifying therapy is associated with lower 30-day hospitalization for heart failure. In clinical practice, clinicians usually focus on acute phase intravenous medications and short-term device therapies and, in fact, neglect short- and long-term comprehensive approaches. This paper reviews management strategies that may help reduce mortality and heart failure rehospitalizations in pre-discharge and post-discharge periods and include adopting holistic approaches for heart failure, increasing optimization of evidence-based therapies, treating cardiac and noncardiac comorbidities, improving care transitions, monitoring, and disease management.
Recommendations for Ramadan Fasting to Patients with Cardiovascular Diseases; Turkish Society of Cardiology Consensus Report
(2021) Alper, Ahmet Taha; Akboga, Mehmet Kadri; Ozcan, Kazim Serhan; Tengiz, Istemihan; Turk, Ugur Onsel; Yildiz, Mustafa; Yilmaz, Mehmet Birhan; Kayikcioglu, Meral; Gazi, Emine; Yildirir, Aylin; 33960303
Relation between serum sodium levels and clinical outcomes in Turkish patients hospitalized for heart failure: a multi-center retrospective observational study
(2017) Muderrisoglu, Haldun; Avci, Burcak Kilickiran; Kucuk, Murathan; Eren, Mehmet; Kutlu, Merih; Yilmaz, Mehmet Birhan; Cavusoglu, Yuksel; Ongen, Zeki; 0000-0002-9635-6313; 27488755; AAG-8233-2020
Objective: The purpose of the study was to analyze the prevalence of hyponatremia and related 1-year outcomes of patients hospitalized for decompensated heart failure with reduced ejection fraction (HFrEF) in Turkish patients. Methods: A total of 500 hospitalized patients with HFrEF were consecutively included in a retrospective study at 19 participating hospitals. Patients were categorized according to their serum sodium levels (sNa) on admission day as normonatremic (135-145 mEq/L) and hyponatremic (< 135 mEq/L). One-year all-cause mortality, re-hospitalization rates, and the impact of the changes in sNa at the time of discharge to clinical outcomes were examined. Results: Hyponatremia was observed in 29% of patients. Patients with hyponatremia had lower blood pressures, creatinine clearance, and left ventricular ejection fraction and higher serum creatinine and BUN levels on admission compared with those with normonatremia. Hyponatremia was associated with higher 1-year all-cause mortality (14% vs. 2.6%, p< 0.001) and re-hospitalization rates (46.9% vs. 33.7%, p=0.005). After adjustment for covariates, hyponatremia was independently associated with 1-year all-cause mortality (adjusted HR, 4.762; 95% CI, 1.941-11.764; p= 0.001). At discharge, only 50.8% of hyponatremic patients were corrected to normonatremia (>= 135 mEq/L). Those with persistent hyponatremia had the highest all-cause mortality (p< 0.001). Conclusion: In this study, it is demonstrated that hyponatremia is relatively common and is associated with increased 1-year all-cause mortality and re-hospitalization rates among Turkish patients hospitalized with HFrEF. Approximately 50% of the patients with initial low sNa had persistent hyponatremia at discharge, and these patients had the worst clinical outcomes.
Snapshot evaluation of acute and chronic heart failure in real-life in Turkey: A follow-up data for mortality
(2020) Yilmaz, Mehmet Birhan; Aksakal, Emrah; Aksu, Ugur; Altay, Hakan; Nesligul, Yildirim; Celik, Ahmet; Akil, Mehmet Ata; Bekar, Lutfu; Vural, Mustafa Gokhan; Guvenc, Rengin Cetin; Ozer, Savas; Ural, Dilek; Cavusoglu, Yuksel; Tokgozoglu, Lale; 32120368; AAE-1392-2021
Objective: Heart failure (HF) is a progressive clinical syndrome. SELFIE-TR is a registry illustrating the overall HF patient profile of Turkey. Herein, all-cause mortality (ACM) data during follow-up were provided. Methods: This is a prospective outcome analysis of SELFIE-TR. Patients were classified as acute HF (AHF) versus chronic HF (CHF) and HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction, and HF with preserved ejection fraction and were followed up for ACM. Results: There were 1054 patients with a mean age of 63.3 +/- 13.3 years and with a median follow-up period of 16 (7-17) months. Survival data within 1 year were available in 1022 patients. Crude ACM was 19.9% for 1 year in the whole group. ACM within 1 year was 13.7% versus 32.6% in patients with CHF and AHF, respectively (p<0.001). Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist were present in 70.6%, 88.2%, and 50.7%, respectively. In the whole cohort, survival curves were graded according to guideline-directed medical therapy (GDMT) scores <= 1 versus 2 versus 3 as 28% versus 20.2% versus 12.2%, respectively (p<0.001). Multivariate analysis of the whole cohort yielded age (p=0.009) and AHF (p=0.028) as independent predictors of mortality in 1 year. Conclusion: One-year mortality is high in Turkish patients with HF compared with contemporary cohorts with AHF and CHF. Of note, GDMT score is influential on 1-year mortality being the most striking one on chronic HFrEF. On the other hand, in the whole cohort, age and AHF were the only independent predictors of death in 1 year.
Sodium glucose co-transporter 2 inhibitors in heart failure therapy
(2020) Cavusoglu, Yuksel; Altay, Hakan; Cahn, Avivit; Celik, Ahmet; Demir, Serafettin; Kilicaslan, Baris; Nalbantgil, Sanem; Raz, Itamar; Temizhan, Ahmet; Yildirimturk, Ozlem; Yilmaz, Mehmet Birhan; AAE-1392-2021; 32281958
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are a new class of drugs for patients with type 2 diabetes (T2DM) which inhibit urinary glucose reabsorption in the proximal tubule of the nephron and result in glucosuria, natriuresis and diuresis. In large, randomized clinical trials, SGLT-2i have been shown to reduce major cardiovascular (CV) events and heart failure (HF) hospitalizations in patients with T2DM who have atherosclerotic CV disease or CV risk factors. In these trials, SGLT-2i is have their greatest and most consistent effect on reducing the risk of HF hospitalization. The reduction in HF hospitalization was also observed in subgroups of patients with a HF diagnosis at baseline, which raised the possibility of a clinical benefit of SGLT-2i in HF patients, regardless of the presence or absence of T2DM. In very recently published DAPA-HF trial, a SGLT-2i, dapagliflozin treatment on top of standard HF therapy has been shown to have clear clinical benefits in terms of reducing HF hospitalization, CV mortality, all-cause mortality and improving quality of life in HF patients. This compelling evidence suggests that SGLT-2i have a potential to be an effective treatment option in HF, regardless of diabetes. This article provides a comprehensive overview focused on the role of SGLT-2i in the treatment of HF.
Vaccination of adults with heart failure and chronic heart conditions: Expert opinion
(2018) Celik, Ahmet; Altay, Hakan; Azap, Alpay; Cavusoglu, Yuksel; Nalbantgil, Sanem; Senol, Esin; Temizhan, Ahmet; Yilmaz, Mehmet Birhan; 30516533