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Öğe Burden of comorbidities in heart failure patients in Türkiye(TUBITAK, 2024-05-07) Çavuşoğlu, Yüksel; Murat, Selda; Şahin, Anıl; Çöllüoğlu, İnci Tuğçe; Ural, Dilek; Yilmaz, Mehmet Birhan; Nalbantgil, Sanem; Nalbantgil, Sanem; Ülgü, Mustafa Mahir; Birinci, Şuayip; Demir, Emre; Kanik, Emine Arzu; Asarcikli, Lale Dinç; Çelik, AhmetBackground/aim: Heart failure (HF) is associated with a wide range of comorbidities that negatively impact clinical outcomes and cause high economic burden. We aimed to evaluate the frequency and burden of comorbidities in HF patients in Türkiye and their relationships with patients’ demographic characteristics. Materials and methods: Based on ICD-10 codes in the national electronic database of the Turkish Ministry of Health covering the entire population of Türkiye (n = 85,279,553) from 1 January 2016 to 31 December 2022, data on the prevalence of comorbidities in HF patients were obtained. The frequency and burden of comorbidities were analyzed separately by age groups, sex, and socioeconomic status (SES). Results: Between 2016 and 2022, there were 2,722,151 patients (51.7% female) of all ages who were diagnosed with HF. In Türkiye, the most common comorbidities of HF patients were hypertension (HT) (97.6%), atherosclerotic cardiovascular disease (ASCVD) (84.9%), dyslipidemia (59.5%), anxiety disorder (48.1%), diabetes mellitus (DM) (45.2%), chronic obstructive pulmonary disease (COPD) (43.6%), anemia (40.6%), and atrial fibrillation (AF) (37.1%). Female patients had higher rates of anemia, DM, HT, and anxiety disorders, while male patients had higher rates of ASCVD, COPD, and dyslipidemia. The most common comorbidity in patients under 20 years of age was congenital heart disease (52.3%). More than 90% of HF patients had ≥2 comorbidities. HF patients with ≥5 comorbidities increased from 18.1% in the group aged 20–49 years to 38.3% in the group aged 50–79 years. Comorbidities were similar across SES groups. Conclusion: The most common comorbidities in cases of HF in Türkiye are HT, ASCVD, dyslipidemia, DM, COPD, anemia, and AF, respectively, and more than 90% of patients have ≥2 comorbidities. While ASCVD and dyslipidemia were more common in male patients, anemia, DM, and anxiety disorders were more common in female patients. The number of comorbid conditions increased with advanced age.Öğe Diagnostic approach to heart failure in Türkiye.(TUBITAK, 2024-05-07) Ural, Dilek; Asarcikli, Lale Dinç; Çöllüoğlu, İnci Tuğçe; Şahin, Anıl; Çavuşoğlu, Yüksel; Yilmaz, Mehmet Birhan; Nalbantgil, Sanem; Ata, Naim; Ülgü, Mustafa Mahir; Birinci, Şuayip; Murat, Selda; Demir, Emre; Kanik, Emine Arzu; Çelik, AhmetBackground/aim: Final diagnosis of heart failure (HF) relies on a combination clinical findings, laboratory and imaging tests. The aim of this study was to review the diagnostic approach to HF in Türkiye. Materials and methods: This study is a subanalysis of the nationwide TRends-HF study, based on anonymized data from National Electronic Database between January 1, 2016, and December 31, 2022. Variables including date of birth, sex, socioeconomic development index, place of initial HF diagnosis, comorbidities, investigations, and diagnostic procedures were reported. Laboratory variables, including complete blood count, natriuretic peptides (NP), estimated glomerular filtration rate, uric acid, electrolytes, albumin, lipid profile, ferritin and hemoglobin A1c levels, and other imaging techniques (coronary angiogram [CAG], transthoracic echocardiography [TTE], chest X-ray [CXR], etc.) during the initial diagnosis and/or follow-up of HF patients, were obtained from the National Electronic Database. The diagnostic test usage rates were analyzed according to years, geographical regions, and socioeconomic regions of Türkiye. Results: The study population consisted of 2,722,151 HF patients (51.7% female, mean age 68.33 ± 14.01 years). All HF patients had at least one electrocardiogram and one TTE examination, and all underwent routine biochemical tests at least once during the follow-up period. CXR utilization rate was 93.7%, while CAG utilization rate was 17.9%. Coronary computed tomographic angiography and cardiac magnetic resonance imaging were performed in only 1.8% and 0.3% of patients, respectively. Among all Turkish HF patients, 16.3% had at least one NP measurement. The highest rate of NP use was observed in the Central Anatolia Region (21.0%), while the lowest rate was in the Aegean Region (11.7%). NP measurement during HF diagnosis revealed a rising trend over time (12.3% in 2016 vs. 26.3% in 2021). Conclusion: The widespread use of TTE at the beginning of the diagnosis and during follow-up is important for providing quality care to HF patients in Türkiye. However, detailed laboratory tests and advanced imaging methods are not utilized sufficiently, which could lead to issues in patient management.Öğe Epidemiology of heart failure in Türkiye(TUBITAK, 2024-12-13) Ata, Naim; Çöllüoğlu, İnci Tuğçe; Şahin, Anıl; Yilmaz, Mehmet Birhan; Nalbantgil, Sanem; Birinci, Şuayip; Ülgü, Mustafa Mahir; Kanik, Emine Arzu; Ural, Dilek; Asarcikli, Lale Dinç; Demir, Emre; Çavuşoğlu, Yüksel; Murat, Selda; Çelik, AhmetBackground/aim: The epidemiological data on heart failure (HF) vary between regions within the same country. We aimed to investigate the epidemiological data on HF in Türkiye across all age groups regarding seven geographical regions. Materials and methods: We included all patients from the Turkish population who received a first diagnosis of HF between January 1, 2016 and December 31, 2022, using ICD-10 codes from the National Electronic Healthcare Database. The data were categorized by seven geographical regions of Türkiye. Results: The median age of index diagnosis of HF was 70 (60–78) years in all age groups and 4 (1–12) years in pediatric population. The prevalence rate of HF was the highest in the Black Sea Region at 3.103%, while the Southeastern Anatolia Region exhibited the lowest at 1.436%. In all age groups, female patients with HF were older and had a higher prevalence rate across all geographical regions than male patients. From 2017 to 2021, incidence rates of HF declined to 3.0 per 1000 person years, with a consistent decrease for each geographical region. The highest incidence rates of HF were seen in the Black Sea Region, while the Southeastern Anatolia Region had the lowest. Evaluating pediatric population with HF, prevalence of HF was 0.81 per 1000 people (female children: 0.77 per 1000 people, male children: 0.84 per 1000 people). Female children with HF demonstrated the highest prevalence in the Central Anatolia Region with a rate of 1.04 per 1000 people, while male pediatric population with HF exhibited the greatest prevalence of HF in the Mediterranean Region, reaching 0.89 per 1000 people. The lowest prevalence of children with HF in both sexes was observed in the Eastern Anatolia Region (female children: 0.62 per 1000 people, male children: 0.48 per 1000 people). Conclusion: Despite regional variations, prevalence of HF in Türkiye’s regions aligns with global trends. Sex-based differences in HF prevalence were evident across all age groups, including pediatric population. Incidence rates of HF in each region exhibited a substantial decline by 2021.Öğe Medical and advanced heart failure therapies in Türkiye(TUBITAK, 2024-05-07) Nalbantgil, Sanem; Demir, Emre; Çelik, Ahmet; Çöllüoğlu, İnci Tuğçe; Ata, Naim; Yilmaz, Mehmet Birhan; Yilmaz, Mehmet Birhan; Kanik, Emine Arzu; Asarcikli, Lale Dinç; Çavuşoğlu, YükselBackground/aim: Effective management of heart failure involves evidence-based use of multiple medications and their combinations. Furthermore, dosage escalation of the recommended medications is advised. In cases of advanced heart failure, long-term mechanical assistance devices or heart transplantation surgery may be necessary. Socio-economic disparities create unequal opportunities for people to access these treatments. The study aimed to analyze and compare medical and advanced heart failure treatments recommended by guidelines across various regions in Türkiye. Materials and methods: About 85 million citizens medical treatment records were utilized between January 1, 2016, and December 31, 2022. Medical and heart replacement treatment opportunities for heart failure in Türkiye were evaluated in the general population and across different geographical regions. Results: According to this study, beta-blockers were the most commonly prescribed medication for heart failure in Türkiye. This was followed by angiotensin-converting enzyme inhibitors at 44% and mineralocorticoid receptor antagonists at 38.9%. However, only 0.6% of patients used angiotensin receptor blocker-neprilysin inhibitors. Despite the high incidence of diabetes mellitus among heart failure patients, only 11% used sodium-glucose cotransporter two inhibitors. The study also found that using an implantable cardioverter defibrillator (ICD) was 0.8%, and cardiac resynchronization therapy (CRT) was 0.3% among all intracardiac device treatments. Heart replacement therapies, cardiac transplantation surgery, and long-term left ventricle-assisted device (LVAD) surgery had very low rates. Conclusion: The use of guideline-directed medical therapy is not optimal in Türkiye and varies across different geographical regions. It is a fact that heart transplant or LVAD surgery, CRT, and ICD implantation rates in Türkiye are significantly lower than those in developed countries, regardless of geographical region.Öğe Outcomes of patients with heart failure in Türkiye(TUBITAK, 2024-06-14) Şahin, Anıl; Yilmaz, Mehmet Birhan; Çelik, Ahmet; Çöllüoğlu, İnci Tuğçe; Ural, Dilek; Asarcikli, Lale Dinç; Nalbantgil, Sanem; Demir, Emre; Çavuşoğlu, Yüksel; Murat, Selda; Kanik, Emine Arzu; Ata, NaimBackground/aim: Despite Türkiye’s relatively young population, there is an emerging trend of earlier diagnoses of chronic diseases, including heart failure (HF). This study aims to shed light on survival rates, potential influences of guideline-directed therapies, and sex-based differences necessitating personalized management in HF. Materials and methods: We conducted a nationwide retrospective cohort analysis of 2,722,151 patients with HF using deidentified data from the Turkish Ministry of Health’s national electronic database. That cohort included 2,701,099 adult patients with HF. Adult patients were divided into two groups based on their outcomes as those who were deceased and those who survived and were then compared. Multivariate regression analysis was conducted to identify variables predicting mortality. The patients’ hospital admissions and length of hospital stay were analyzed based on survival status and age. Results: Out of 2,722,151 HF patients, the overall mortality rate was 33.7%, with a difference observed according to sex (32.5% in female patients, 35.0% in male patients). Survival rates at 1, 5, and 7 years after the HF diagnosis were detailed. Deceased HF patients had more comorbidities, higher natriuretic peptides, and lower glomerular filtration rates. Hospitalization patterns varied, with 41% experiencing no hospitalization. The average length of hospital stay in 2022 was 6 days, with sex-and age-specific disparities. Conclusion: The survival rate of HF in Türkiye is similar to world data. The survival of female patients is better than that of male patients. Increased survival rates can likely be attributed to the widespread use of guideline-directed therapies. Finally, high healthcare utilization is observed, especially in emergency situations.Öğe Tek silindirli buji ateşlemeli bir motorda elektromekanik supap uygulaması ve testi(Karabük Üniversitesi, 2016) Demir, Emre; Sekmen, YakupElektromekanik supap (EMS) sistemleri içten yanmalı motorlarda kam milinden bağımsız bir çalışma sağlamaktadır. Bu özelliği sayesinde sonsuz değişkenlikte supap zamanlamasına imkân vermektedir. EMS mekanizmaları supabı çok kısa sürede açıp kapatmalı ve güvenilir bir supap performansı sağlamalıdır. EMS sistemleri, içten yanmalı motorlarda motor performansını yükseltip, özgül yakıt tüketimini ve çevreye atılan kirletici oranlarını azaltmaktadır. Bu çalışmada, düşük voltajlarla çalışabilen bir EMS mekanizmasının deney motoru silindir kapağına montajı yapılarak, motorun orijinal supap sistemi ve EMS sistemi ile performans ve emisyon testleri gerçekleştirilmiştir.
