Post-discharge heart failure monitoring program in Turkey: Hit-PoinT

Objective: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. Methods: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Results: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). Conclusion: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients.Türk Kardiyoloji Derneği Kalp Yetmezliği Çalışma Grub

Decline in mean platelet volume in patients with patent foramen ovale undergoing percutaneous closure : cardiovascular topic

INTRODUCTION: The presence of patent foramen ovale (PFO) is considered a possible cause for cryptogenic stroke. The mechanism underlying the ischaemic neurological events in the presence of PFO has not been firmly established. The purpose of this study was to compare: (1) the mean platelet volume levels in PFO patients with and without a cryptogenic stroke, and (2) pre- and post-procedural mean platelet volumes (MPV) in patients undergoing percutaneous PFO closure. METHODS: Sixteen PFO patients undergoing percutaneous closure to prevent recurrent ischaemic events and 15 asymptomatic patients with PFO were enrolled in the study. Mean platelet volume was compared between patients with and without a history of stroke. We also compared pre- and postprocedural MPV levels in patients undergoing percutaneous PFO closure. RESULTS: Mean platelet volume, which is a marker for platelet activity, was similar in PFO patients with and without stroke (9.34 ± 1.64 vs 9.1 ± 1.34 fl; p = 0.526). Interestingly, MPV decreased significantly after percutaneous closure compared to pre-procedural levels (9.34 ± 1.64 vs 8.3 ± 1.12 fl; p = 0.001). CONCLUSION: Our findings suggest interatrial communication through a PFO may be related to increased MPV and increased platelet activity

Decline in mean platelet volume in patients with patent foramen ovale undergoing percutaneous closure

Introduction: The presence of patent foramen ovale (PFO) is considered a possible cause for cryptogenic stroke. The mechanism underlying the ischaemic neurological events in the presence of PFO has not been firmly established. The purpose of this study was to compare: (1) the mean platelet volume levels in PFO patients with and without a cryptogenic stroke, and (2) pre- and post-procedural mean platelet volumes (MPV) in patients undergoing percutaneous PFO closure

Türkiye’deki kardiyologların mevcut “malpraktis” sistemi ve alternatif “malpraktis” sistem önerisi hakkındaki görüşleri

WOS: 000418480800009PubMed ID: 28990944Objective: Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system. Methods: The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message. Results: A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients. Conclusion: The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.Amaç: Kardiyologlar birçok riskli hastanın teşhis, tedavi ve girişimsel tedavisiyle uğraşmaktadırlar. Bu çalışmada Türkiye’deki mevcut “malpraktis” sisteminin kardiyologların tanı ve tedavi yaklaşımlarını nasıl etkilediğini ve önerdiğimiz yeni hasta tazminat sistemine yaklaşımlarını inceledik. Yöntemler: Bu kesitsel çalışmada Türk sağlık sisteminin farklı seviyelerinde çalışan kardiyologların mesleki risk algılarının uygulamalarına etkisini araştırma amacıyla 24 soruluk bir anketi asistan, uzman ve öğretim üyelerine elektronik posta, basılı evrak ve cep telefonu mesajı ile gönderildi. Bulgular: Ankete toplam 253 kardiyolog cevap verdi. Bunların 29’una (%11.6) geçmişte malpraktis talepleri için dava açılmıştı. Dava edilen kardiyologların 2’sine (%6.9) maddi tazminat talebinde bulunuldu, 1’ine (%3.4) ihmal nedeniyle hapis cezası verildi. Bunun yanında 132 (%52.8) kardiyolog “malpraktis” korkusu nedeni ile pratiklerinde değişiklik yaptıklarını bildirmekteydi. Ayrıca 232 (%92.8) kardiyolog önerdiğimiz hasta tazminat sistemini tercihe değer buluyordu. Kardiyologların %78.8’i bilgisayarlı tomografik anjiyografi (BTA) veya perfüzyon sintigrafisi, %71.6’sı koroner anjiyografi, %20 ’si stent implantasyonu, %83.2’si ise yüksek riskli hastalardan kaçınma kararlarında malpraktisten kaçınmanın etkili olduğu kanaatindeydi. Sonuç: “Malpraktis” korkusu kardiyologlarda yüksek oranlarda gereksiz test isteme, girişim yapma veya yüksek riskli hastalardan kaçınma eğilimi yaratmaktadır. Önerdiğimiz yeni “malpraktis” sistemi çalışmaya katılan kardiyologların büyük çoğunluğu tarafından mevcut sisteme tercih edilir bulunmuştur.Cardiovascular Academy Society of TurkeyThis work was supported by the Cardiovascular Academy Society of Turkey

Quality of life of patients with atrial septal defect following percutaneous closure

Introduction: Quality of life has become an important outcome measure in addition to mortality and morbidity in patients with congenital heart disease. Atrial septal defect is a common congenital heart disease, and transcatheter atrial septal defect closure has become an accepted treatment modality. The aim of this study is to assess the quality of life of patients with atrial septal defect who underwent percutaneous closure. Materials and methods: We examined the quality of life of 69 patients with atrial septal defect and 69 healthy controls matched according to age, sex, educational level, and economic, marital, and employment status. Quality of life was investigated using the Turkish version of Short Form-36. Results: The mean age of the patients was 39.7 +/- 14.2 and 26% were male. The quality of life assessment was performed at a mean follow-up time of 18.0 +/- 13.8 months after the intervention. The mean scores of the domains of the Short Form-36, namely, physical functioning, role functioning, social functioning, mental health, vitality, pain, and general health, were similar in patients with atrial septal defect who underwent percutaneous closure and the control group. Conclusion: Adult patients who underwent percutaneous atrial septal defect closure perceive their quality of life to be as good as their healthy counterparts

The opinion of Turkish cardiologists on current malpractice system and an alternative patient compensation system proposal: PCS study group

Amaç: Kardiyologlar birçok riskli hastanın teşhis, tedavi ve girişimsel tedavisiyle uğraşmaktadırlar. Bu çalışmada Türkiye'deki mevcut "malpraktis" sisteminin kardiyologların tanı ve tedavi yaklaşımlarını nasıl etkilediğini ve önerdiğimiz yeni hasta tazminat sistemine yaklaşımlarını inceledik.Yöntemler: Bu kesitsel çalışmada Türk sağlık sisteminin farklı seviyelerinde çalışan kardiyologların mesleki risk algılarının uygulamalarına etkisini araştırma amacıyla 24 soruluk bir anketi asistan, uzman ve öğretim üyelerine elektronik posta, basılı evrak ve cep telefonu mesajı ile gönderildi.Bulgular: Ankete toplam 253 kardiyolog cevap verdi. Bunların 29'una (%11.6) geçmişte malpraktis talepleri için dava açılmıştı. Dava edilen kardiyologların 2'sine (%6.9) maddi tazminat talebinde bulunuldu, 1'ine (%3.4) ihmal nedeniyle hapis cezası verildi. Bunun yanında 132 (%52.8) kardiyolog "malpraktis" korkusu nedeni ile pratiklerinde değişiklik yaptıklarını bildirmekteydi. Ayrıca 232 (%92.8) kardiyolog önerdiğimiz hasta tazminat sistemini tercihe değer buluyordu. Kardiyologların %78.8'i bilgisayarlı tomografik anjiyografi (BTA) veya perfüzyon sintigrafisi, %71.6'sı koroner anjiyografi, %20'si stent implantasyonu, %83.2'si ise yüksek riskli hastalardan kaçınma kararlarında malpraktisten kaçınmanın etkili olduğu kanaatindeydi.Sonuç: "Malpraktis" korkusu kardiyologlarda yüksek oranlarda gereksiz test isteme, girişim yapma veya yüksek riskli hastalardan kaçınma eğilimi yaratmaktadır. Önerdiğimiz yeni "malpraktis" sistemi çalışmaya katılan kardiyologların büyük çoğunluğu tarafından mevcut sisteme tercih edilir bulunmuşturObjective: Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists’ diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system.Methods: The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message.Results: A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients.Conclusion: The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice syste

Post-discharge heart failure monitoring program in Turkey: Hit-PoinT

WOS: 000396901400006PubMed ID: 27488754Objective: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. Methods: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Results: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). Conclusion: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patientsWorking Group on Heart Failure of the Turkish Society of CardiologyThis study had been designed, supported and conducted by the Working Group on Heart Failure of the Turkish Society of Cardiology