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Permanent URI for this collectionhttps://hdl.handle.net/11727/10760
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Item 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-9349-2021Objective: 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.Item 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; 32281958Sodium-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.Item Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice(2015) Cavusoglu, Yuksel; Altay, Hakan; Ekmekci, Ahmet; Eren, Mehmet; Kucukoglu, Mehmet Serdar; Nalbantgil, Sanem; San, Ibrahim; Selcuk, Timur; Temizhan, Ahmet; Ural, Dilek; 26574641Heart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature.