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    The Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER)
    (Via Medica, 2013) Ertas, Faruk; Eren, Nihan Kahya; Kaya, Hasan; Aribas, Alpay; Acar, Goksel; Kanadasi, Mehmet; Gedik, Selcuk
    Background: AFTER (Atrial Fibrillation in Turkey: Epidemiologic Registry) is a prospective, multicenter study designed with the aim of describing the prevalence and epidemiology of AF practice in Turkey. This study aims to evaluate stroke risk in non-valvular atrial fibrillation (AF) and anticoagulant drug utilization within conformity to AF guidelines. Methods: Patients were recruited in 17 referral hospitals reflecting all the population of 7 geographical regions of Turkey. 2242 consecutive patients who had been admitted with AF on ECG were included in the study. 1745 of these patients, who had non-valvular AF, were included in the statistical evaluation. Stroke risk was evaluated with the CHA(2)DS(2)-VASc score. Results: The average age of participants was determined to be 69.2 +/- 11.5 years (56% female). Persistent-permanent AF was found to be the most common type of non-valvular AF (78%). The most common comorbid disorder was hypertension (73%). It was found that oral anticoagulant therapy was used by 40% of all patients, 37% of whom had effective INR (2.0-3.0). Upon multivariate analysis, age was found to be the only independent predictor of stroke among the variables' effects on thromboembolic events that created CHA2DS2-VASc abbreviations (OR 1.026, p < 0.001). Conclusions: These results suggest that stroke risk scores should be thoroughly heeded based on guidelines, and that anticoagulation must be applied according to their guidance.
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    Cardiac device-related infective endocarditis; analysis of 15 cases
    (Turkish Soc Cardiology, 2013) Elbey, Mehmet Ali; Eren, Nihan Kahya; Kalkan, Mehmet Emin; Demirtas, Sinan; Kahraman, Fatih; Sayin, Rasit; Oylumlu, Mustafa
    Objectives: We aimed to investigate the demographic and clinical characteristics, echocardiographic and microbiologic features, and outcomes of patients with permanent pacemaker (PM), and implantable cardioverter-defibrillator (ICD) - related endocarditis in this study. Study design: The study population consisted of 15 patients with permanent PM and ICD-related endocarditis. Data on patients'demographic characteristics, medications used, clinical, and microbiological data, echocardiographic findings, types, and outcomes of surgical treatments were recorded. Results: The mean age of the patients was 57+/-16. Seven patients (47%) were female. Of the 15 patients with permanent PM and ICD-related endocarditis, 5 died during in-hospital follow-up (33%). In four patients (27%) pulmonary embolism developed. Culture-negative endocarditis was detected in 5 cases (33%). Staphylococci were the most common causative organisms in 60% of the patients. Three (20%). patients underwent surgical treatment Conclusion: Cardiac device-related endocarditis remains a rare complication of intracardiac device implantation still with higher mortality rates.
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    Demographical data and outcomes of surgically treated patients with the diagnosis of infective endocarditis: a multi-center retrospective study
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2014) Oylumlu, Mustafa; Elbey, Mehmet Ali; Kalkan, Emin; Akdag, Serkan; Ozbek, Kerem; Eren, Nihan Kahya; Topcu, Selim
    Background: This study aims to investigate the demographic and clinical characteristics and echocardiographic and microbiological findings of the patients as well as the outcomes of surgery undergoing surgical treatment with the diagnosis of infective endocarditis in Turkey. Methods: Between January 2005 and August 2012 116 patients (65 males, 51 females; mean age 43 +/- 16 years; range 14 to 80 years) with the diagnosis of infective endocarditis who underwent surgery in 13 tertiary university/research and education hospitals were included in this multi-center study. Demographic and clinical characteristics of the patients, and echocardiographic and microbiological findings, surgical indications and outcomes of surgery were retrospectively analyzed. Results: The most common symptom on admission and physical finding was fever. Blood cultures were negative in 35 patients (30%). Staphylococci were the most common microbiological pathogens (22%). Congestive heart failure was the most common indication for surgery in 56 patients (48%). Valve repair was performed in 12 patients (10%), valve replacement was the procedure of choice in 104 patients (90%). Thirty-three patients undergoing surgical treatment died in the postoperative period. The mortality rate was 28%. Independent predictors of surgical mortality were Class 3-4 functional capacity, elevated C-reactive protein, and renal dysfunction. Conclusion: Although complicated cases of infective endocarditis can be treated through surgery, surgical morbidity and mortality is still high.
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    Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER* study
    (Turkish Soc Cardiology, 2013) Ertas, Faruk; Kaya, Hasan; Kaya, Zekeriya; Bulur, Serkan; Kose, Nuri; Gul, Mehmet; Eren, Nihan Kahya
    Objectives: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. Study design: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. Results: The mean age of the patients was determined as 66.8+/-12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (% 67) was the most common comorbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. Conclusion: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.
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    Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation: Results from Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER)
    (Via Medica, 2014) Kaya, Hasan; Ertas, Faruk; Kaya, Zekeriya; Eren, Nihan Kahya; Yuksel, Murat; Koroglu, Bayram; Kose, Nuri
    Background: The aim of this study was to perform a multicenter, prospective investigation regarding the epidemiology, the current effectiveness of therapeutic anticoagulation, and the risk of thromboembolism in patients with valvular atrial fibrillation (AF) based on the records of the Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. Methods: Patients were selected from a total of 2,242 consecutive admissions that presented with AF diagnosed via electrocardiogram. Those diagnosed with non-valvular AF were excluded from the AFTER study population, which left 497 patients with valvular AF for analysis. Results: The etiology of valvular AF in patients was either attributed to rheumatic mitral valve stenosis (n = 217) or possessing a prosthetic heart valve (n = 280). Out of all the patients with valvular AF, 83.1% were taking warfarin for anticoagulation. Only 36.1% demonstrated a therapeutic international normalized ratio (INR), and among those patients it was found that 19.1% exhibited a labile INR. Multivariate analysis revealed that age was the only independent predictor of thromboembolic events in patients with valvular AF. Conclusions: Many valvular AF patients are not maintained at therapeutic INR levels, which poses a threat to patient health as they age and are at greater risk for thromboembolism.
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    Kardiyak cihazlara bağlı olarak gelişen enfektif endokardit; 15 olgunun analizi
    (2013) Eren, Nihan Kahya; Demirtaş, Sinan; Elbey, Mehmet Ali; Oylumlu, Mustafa; Kalkan, Mehmet Emin; Sayın, Muhammet Raşit; Kayan, Fethullah
    Amaç: Bu çalışmada, kalıcı pacemaker (PM) ve implante edilebilir kardiyoversiyon defibrilatörleri (ICD) ile ilişkili endokarditin demografik, klinik ekokardiyografik ve mikrobiyolojik özellikleri ve sonuçlarının araştırılması amaçlandı.Çalışma planı: Kalıcı PM ve ICD endokarditi tanısı olan 15 hasta çalışmaya alındı. Hastaların demografik özelikleri, kullandıkları ilaçlar, klinik ve mikrobiyolojik özellikleri, ekokardiyografi sonuçları, cerrahi tedavi ve sonuçları kaydedildi.Bulgular: Hastaların ortalama yaşı 57±16 ve 7si (%47) kadındı. Kalıcı PM ve ICDsi olan 15 hastadan 5i takip sırasında kaybedildi (%33). Dört hastada pulmoner emboli gelişti (%27). Kan kültürü 5 hastada (%33) negatif bulundu. Hastaların %60ında üretilen stafilokoklar en sık saptanan mikrobiyolojik ajanlardı. Üç hastaya (%20) cerrahi tedavi uygulandı.Sonuç: Kardiyak cihazlarla ile ilişkili endokardit, kardiyak cihaz implantasyonun nadir bir komplikasyonu olmasına rağmen mortalitesi halen yüksek olan bir hastalıktır.
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    Predictors of mortality in patients with prosthetic valve infective endocarditis: A nation-wide multicenter study
    (Via Medica, 2013) Elbey, Mehmet Ali; Kalkan, Mehmet Emin; Akdag, Serkan; Ozbek, Kerem; Eren, Nihan Kahya; Demirtas, Sinan; Akil, Mehmet Ata
    Background: Our aim was to investigate the clinical and prognostic features of the patients with prosthetic valve endocarditis (PVE) in a multicenter nation-wide study. Methods: The present nation-wide study consisted of 75 consecutive patients with PVE treated at 13 major hospitals in Turkey from 2005 to 2012. Results: The patients who died during follow-up were significantly older than the survivors and had higher C-reactive protein (CRP), creatinine, poor NYHA functional class and large vegetations. High creatinine level (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.14-6.13), poor functional status (OR 24.5; 95% CI 3.1-196.5) and high CRP (OR 1.02; 95% CI 1.00-1.03) measured on admission were independent risk associates for in-hospital mortality Conclusions: High creatinine level, poor functional status and high CRP measured on admission were independent risk associates for in-hospital mortality, whereas a NYHA class of III/IV and high CRP reflected independent risk for stroke/mortality end point.