Türkiye'de koroner yoğun bakım ünitelerindeki hastane içi mortalite (MORCOR-TURK) çalışmasında hasta temel karakteristikleri ve öngördürücüleri

OBJECTIVE: The MORtality in CORonary Care Units in Türkiye (MORCOR-TURK) trial is a national registry evaluating predictors and rates of in-hospital mortality in coronary care unit (CCU) patients in Türkiye. This report describes the baseline demographic characteristics of patients recruited for the MORCOR-TURK trial. METHODS: The study is a multicenter, cross-sectional, prospective national registry that included 50 centers capable of 24-hour CCU service, selected from all seven geographic regions of Türkiye. All consecutive patients admitted to CCUs with cardiovascular emergencies between September 1-30, 2022, were prospectively enrolled. Baseline demographic characteristics, admission diagnoses, laboratory data, and cardiovascular risk factors were recorded. RESULTS: A total of 3,157 patients with a mean age of 65 years (range: 56-73) and 2,087 (66.1%) males were included in the analysis. Patients with arterial hypertension [1,864 patients (59%)], diabetes mellitus (DM) [1,184 (37.5%)], hyperlipidemia [1,120 (35.5%)], and smoking [1,093 (34.6%)] were noted. Non-ST elevation myocardial infarction (NSTEMI) was the leading cause of admission [1,187 patients (37.6%)], followed by ST elevation myocardial infarction (STEMI) in 742 patients (23.5%). Other frequent diagnoses included decompensated heart failure (HF) [339 patients (10.7%)] and arrhythmia [272 patients (8.6%)], respectively. Atrial fibrillation (AF) was the most common pathological rhythm [442 patients (14%)], and chest pain was the most common primary complaint [2,173 patients (68.8%)]. CONCLUSION: The most common admission diagnosis was acute coronary syndrome (ACS), particularly NSTEMI. Hypertension and DM were found to be the two leading risk factors, and AF was the most commonly seen pathological rhythm in all hospitalized patients. These findings may be useful in understanding the characteristics of patients admitted to CCUs and thus in taking precautions to decrease CCU admissions

Wpływ terapii iwabradyną i beta-adrenolitykami na zaburzenia rytmu wywołane próbą dobutaminową

Background: Indirect evidences suggest that the If blocker ivabradine may exert an antiarrhythmic effect in ventricular myocardium in heart failure (HF) patients by inhibiting spontaneous depolarisations, but the clinical relevance of this mechanism is not known. Dobutamine (DOB) has been known to increase heart rate and the incidence of cardiac arrhythmias. Aim: In this study, we evaluated the effects of ivabradine on DOB-induced ventricular arrhythmias and compared them with those of beta-blocker (BB) therapy. Methods: Patients with decompensated HF requiring inotropic support, left ventricular ejection fraction < 35%, and in sinus rhythm were included in the study (ivabradine group — 29 patients, control group — 29 patients, BB group — 15 patients). All patients underwent Holter recording for 6 h before the initiation of DOB infusion. Following baseline recording, DOB was administered at incremental doses of 5, 10, and 15 μg/kg/min, with 6-h steps. Holter monitoring was continued during 18 h of DOB infusion and analysed for the median number of ventricular premature contractions (VPC), ventricular couplets, episodes of non-sustained ventricular tachycardia, and total ventricular arrhythmias in each step of the study protocol. Results: The positive chronotropic effect of incremental DOB doses was blunted by beta-blockade and was totally abolished by ivabradine. The median number of VPCs, ventricular couplets, and total ventricular arrhythmias significantly increased with incremental doses of DOB in the control group (p = 0.018) and, to a lesser extent, in the ivabradine group (p = 0.015). In the BB group the absolute VPCs numbers were smaller than in the control or the ivabradine group, with the on-ivabradine VPCs numbers falling between those seen in control and BB groups. A numeric increase in VPCs with incremental DOB doses occurred in the BB group but did not reach statistical significance (p > 0.05), consistent with a protective effect of beta-blockade. Ivabradine reduced VPCs by 43% at 5 μg/kg/min DOB and by 38% at 10 μg/kg/min DOB against the control group (VPCs median 256 vs. 147 and 251 vs. 158) in the absence of significant differences at 15 μg/kg/min DOB between the control and ivabradine groups (overall p > 0.05). Thus, ivabradine administered without background beta-blockade attenuated the arrhythmogenic effect of increasing doses of DOB in the low and moderate DOB dose but not in the high DOB dose. Conclusions: In patients with decompensated HF, ivabradine appears to reduce the incidence of VPCs in response to low and medium DOB dose. Whether the anti-arrhythmic effect of ivabradine is additive to the anti-arrhythmic effect of beta-blockade requires further investigation; this should also determine the clinical significance of ventricular arrhythmia attenuation with ivabradine.Wstęp: Pośrednie dane z badań naukowych sugerują, że iwabradyna, lek hamujący kanały If, może działać antyarytmicznie na mięśniówkę komór u osób z niewydolnością serca poprzez hamowanie spontanicznej depolaryzacji, jednak znaczenie kliniczne tego mechanizmu nie jest znane. Wiadomo, że dobutamina (DOB) zwiększa częstotliwość rytmu serca oraz zapadalność na zaburzenia rytmu serca. Cel: Celem niniejszej pracy była ocena wpływu iwabradyny na wywołane DOB arytmie komorowe i porównanie go z działaniem leków beta-adrenolitycznych. Metody: Do badania włączono chorych z niewyrównaną niewydolnością serca wymagających stosowania leków o działaniu inotropowym dodatnim, z frakcją wyrzutową lewej komory wynoszącą < 35%, z rytmem zatokowym (29 chorych w grupie leczonej iwabradyną, 29 chorych w grupie kontrolnej, 15 chorych leczonych beta-adrenolitykiem). Wszystkim pacjentom 6 godzin przez rozpoczęciem infuzji DOB podłączano monitor holterowski EKG. Po uzyskaniu wstępnego zapisu chorym podawano DOB w dawkach zwiększanych stopniowo co 6 godzin i wynoszących 5, 10 i 15 μg/kg/min. Zapis holterowski kon­tynuowano przez 18 godzin podawania DOB, a następnie analizowano pod kątem średniej liczby przedwczesnych skurczów komorowych (VPC), par pobudzeń komorowych, epizodów nieutrwalonego częstoskurczu komorowego i liczby wszystkich zaburzeń komorowych na każdym etapie protokołu badania. Wyniki: Chronotropowe dodatnie działanie wzrastających dawek DOB zostało osłabione przez leki beta-adrenolityczne i całkowicie zniesione przez iwabradynę. W grupie kontrolnej mediany liczby VPC, par pobudzeń i liczby zaburzeń rytmu ogółem zwiększały się istotnie wraz ze wzrastającymi dawkami DOB (p = 0,018), co było również widoczne, ale w mniej­szym stopniu, w grupie przyjmującej iwabradynę (p = 0,015). W grupie leczonej beta-adrenolitykiem bezwzględna liczba VPC była mniejsza niż w grupie kontrolnej i u osób przyjmujących iwabradynę, przy czym liczba VPC w grupie stosującej iwabradynę miała wartość pośrednią między pozostałymi grupami. W grupie przyjmującej beta-adrenolityk odnotowano wzrost liczby VPC w miarę zwiększania dawek DOB, jednak nie osiągnął on istotności statystycznej (p > 0,05), co jest zgodne z ochronnymi właściwościami leków z tej grupy. Iwabradyna spowodowała zmniejszenie liczby VPC o 43% przy dawce DOB wynoszącej 5 μg/kg/min i o 38% przy dawce DOB wynoszącej 10 μg/kg/min w porównaniu z wartościami stwierdzonymi w grupie kontrolnej (mediana VPC 256 vs. 147 oraz 251 vs. 158), natomiast nie odnotowano istotnych różnic między grupą kontrolną a osobami stosującymi iwabradynę w przypadku dawki DOB wynoszącej 15 μg/kg/min (p > 0,05). Iwabradyna przyjmowana bez leku beta-adrenolitycznego osłabiła arytmogenne działanie wzrastających dawek DOB w przypadku dawek niskich i średnich, lecz nie powodowała takiego efektu przy wysokich dawkach DOB. Wnioski: U chorych z niewyrównaną niewydolnością serca iwabradyna wpłynęła na zmniejszenie liczby VPC wywołanych niską lub pośrednią dawką DOB. Należy przeprowadzić dalsze badania w celu ustalenia, czy łączne stosowanie iwabradyny z beta-adrenolitykiem pozwoli uzyskać addytywny efekt przeciwarytmiczny. Trzeba również określić znaczenie kliniczne działania iwabradyny zmniejszającego skłonność do arytmii komorowych

EPHESUS (Kılavuzlara Uyumun, Bilgi ve Algı Düzeylerinin Gerçek Yaşamda Saptanması) çalışmasının temel, tasarım ve metodolojisi

Objective: A wide gap exists between dyslipidemia guidelines and their implementation in the real world, which is primarily attributed to physician and patient compliance. the aim of this study is to determine physician and patient adherence to dyslipidemia guidelines and various influential factors. Methods: the Evaluation of Perceptions, Knowledge, and Compliance with the Guidelines in Real Life Practice: A Survey on the Under-treatment of Hypercholesterolemia (EPHESUS) trial (ClinicalTrials.gov number NCT02608645) will be an observational, multicenter, non-interventional study. the study targets enrollment of 2000 patients from 50 locations across Turkey. All of the data will be collected in a single visit and current clinical practice will be evaluated. A cross-sectional survey of public perception and knowledge of cholesterol treatment among Turkish adults will be performed. All consecutive patients admitted to cardiology clinics who are in the secondary prevention group (coronary heart disease, peripheral artery disease, atherosclerotic cerebrovascular disease) and who are in the high-risk primary prevention group (type 2 diabetes mellitus with no prior known coronary heart disease; patients who had markedly elevated single risk factors, in particular, cholesterol >8 mmol/L [>310 mg/dL], blood pressure ?180/110 mmHg, a calculated Systematic Coronary Risk Evaluation [SCORE] ?5%, or 8 mmol/L (>310 mg/dL) veya kan basıncı ?180/110 mmHg veya hesaplanmış SCORE değeri 10 yıl için ölümcül kardiyovasküler hastalık riski ?%5 ve <10% olanlar) olan tüm hastalar dahil edilecektir. Demografik, yaşam tarzı, tıbbi ve terapötik veriler bu özel anketle toplanacaktır. Sonuç: EPHESUS kayıtları, hem ikincil korunma, hem de yüksek riskli hastalarda birincil korunmada dislipidemi kılavuzlarına uyumu değerlendiren en büyük çalışma olacaktır

Misperceptions and management of LDL-cholesterol in secondary prevention of patients with familial hypercholesterolemia in cardiology practice: Real-life evidence from the EPHESUS registry

BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is a common inherited disease, leading to premature atherosclerotic cardiovascular disease (ASCVD) due to elevated low-density lipoprotein cholesterol (LDL-C) levels. Achieving LDL-C goals is extremely important for preventing the complications of this fatal disease. We evaluated the management of FH patients with ASCVD in cardiology practice. METHODS: We analyzed patients with ASCVD from the nationwide EPHESUS registry, which was conducted in 40 cardiology outpatient clinics, and compared those with and without FH. RESULTS: Of the 1482 consecutively enrolled patients with ASCVD, 618 (41.7%) had FH, among which 455 were categorized as 'Possible FH' and 163 as 'Probable or Definite FH'. Proposed LDL-C goals were not attained in more than 90% of the patients with FH. The proportion of those on statin therapy was 77% for possible and 91% for probable or definite FH, whereas 34.2 % and 59.4% were in use of high-intensity statins, respectively. None of the patients were on PCSK-9 inhibitors, and only 2 used ezetimibe. Adverse media coverage was the most common cause of statin discontinuation (32.5% in 'possible FH' and 45.7% in 'probable/definite FH'). The negative impact of media in the decision to stop lipid lowering therapy (LLT) was increasing with education level. CONCLUSIONS: In real life most of the FH patients with ASCVD are undertreated in cardiology practice regarding statin dosing and combined LLT. Drug discontinuation rates are notably high and are mostly media-related, and side effects very rarely cause cessation of LLT. Urgent measures are needed to increase the awareness of FH among healthcare providers and patients and to develop improved treatment strategies aimed at preventing the complications of FH

The association of exaggerated hypertensive response to exercise and beta-blockers use in hypertensives

Purpose An elevation in blood pressure (BP) during exercise is the normal physiological response, however an abnormally exaggerated rise in BP, in terms of hypertensive response to exercise (HRE), is seen as a prognostic factor for end-organ damage and mortality. HRE is more common in hypertensive (HT) patients and data are lacking on the effect of antihypertensive medication on HRE. In this study, we evaluated patients who underwent treadmill exercise testing (TET) to reveal the effect of antihypertensive medication on HRE. Materials and Methods A cohort of 2970 individuals underwent TET and data were evaluated for HRE development. HRE has been defined as a systolic BP>210 mmHg in males and >190 mmHg in females throughout the TET. To reveal the effects of antihypertensive medication on HRE, 992 HT patients were analyzed. Results HRE was observed in 11.4% (n = 113) of HT patients and 5.9% (n = 107) of non-HT individuals(p < .001). HRE was observed significantly more in males (57.6% vs. 67.3%;p = .033), and in patients with higher body mass index BMI (29.1 ± 4.5 vs. 30.3 ± 5.2;0.033). There was no significant association between medication and HRE development apart from beta-blockers. Also, gender (odds ratio:1.787; 95%CI:1.160–2.751;p = .008), BMI (odds ratio:1.070;95%CI:1.025–1.116;p = .002) and being under beta-blocker treatment (odds ratio:0.637;95%CI:0.428–0.949;p = .026) were found to be independent predictors of HRE in multivariate logistic regression analysis. Conclusion HRE was associated with gender, BMI and beta-blocker use in hypertensive with male gender and higher BMI associated with higher HRE, while beta-blocker-based treatment, either mono- or combination therapy, associated with lower HRE

Suboptimal use of non-vitamin K antagonist oral anticoagulants: Results from the RAMSES study

WOS: 000384041400052PubMed ID: 27583892This study aimed to investigate the potential misuse of novel oral anticoagulants (NOACs) and the physicians' adherence to current European guideline recommendations in real-world using a large dataset from Real-life Multicenter Survey Evaluating Stroke Prevention Strategies in Turkey (RAMSES Study).RAMSES study is a prospective, multicenter, nationwide registry (ClinicalTrials.gov identifier NCT02344901). In this subgroup analysis of RAMSES study, patients who were on NOACs were classified as appropriately treated (AT), undertreated (UT), and overtreated (OT) according to the European Society of Cardiology (ESC) guidelines. The independent predictors of UT and OT were determined by multivariate logistic regression.Of the 2086 eligible patients, 1247 (59.8%) received adequate treatment. However, off-label use was detected in 839 (40.2%) patients; 634 (30.4%) patients received UT and 205 (9.8%) received OT. Independent predictors of UT included >65 years of age, creatinine clearance 50mL/min, urban living, existing dabigatran treatment, and HAS-BLED score of <3, whereas that of OT were creatinine clearance <50mL/min, ongoing rivaroxaban treatment, and HAS-BLED score of 3.The suboptimal use of NOACs is common because of physicians' poor compliance to the guideline recommendations in patients with nonvalvular atrial fibrillation (NVAF). Older patients who were on dabigatran treatment with good renal functions and low risk of bleeding were at risk of UT, whereas patients who were on rivaroxaban treatment with renal impairment and high risk of bleeding were at risk of OT. Therefore, a greater emphasis should be given to prescribe the recommended dose for the specified patients