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1. Analysis of geographical variations in the epidemiology and management of non-valvular atrial fibrillation: results from the RAMSES registry.

Author

Doğan V, Başaran Ö, Biteker M, Özpamuk Karadeniz F, Tekkesin Aİ, Çakıllı Y, Türkkan C, Hamidi M, Demir V, Gürsoy MO, Tek Öztürk M, Aksan G, Seyis S, Ballı M, Alıcı MH, Bozyel S, and Kırma C

Subjects
Aged, Anticoagulants administration & dosage, Anticoagulants therapeutic use, Atrial Fibrillation drug therapy, Atrial Fibrillation etiology, Demography, Female, Humans, Male, Registries, Risk Factors, Socioeconomic Factors, Turkey epidemiology, Atrial Fibrillation epidemiology
Abstract

Objective: This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey., Methods: In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence., Results: In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (1677, 26.7%). All demographic characteristics were significantly different among regions. Preferred oral anticoagulants (OACs) also differed between geographical regions; non-vitamin K OACs were preceded by warfarin in East Anatolia, Aegean, Southeast Anatolia, and Black Sea. Nearly one-third of the patients (28%) did not receive any OAC therapy. However, the number of patients not receiving any OAC therapy was higher in Southeast Anatolia (51.1%) and East Anatolia (46.8%) compared with other geographical regions of Turkey. Inappropriate use of OACs was also more common in East and Southeast Anatolia., Conclusion: This study was the first to show that the demographic differences among the geographical regions may result in different preferences of stroke prevention strategies in Turkey. OACs are still under- or inappropriately utilized, particularly in the eastern provinces of Turkey.

Published
2017
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2. Real-World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl-life Multicenter Survey Evaluating Stroke Study.

Author

Biteker M, Başaran Ö, Doğan V, Altun İ, Özpamuk Karadeniz F, Tekkesin Aİ, Çakıllı Y, Türkkan C, Hamidi M, Demir V, Gürsoy MO, Tek Öztürk M, Aksan G, Seyis S, Ballı M, Alıcı MH, and Bozyel S

Subjects
Administration, Oral, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Risk Factors, Stroke prevention & control, Turkey, Anticoagulants therapeutic use, Atrial Fibrillation drug therapy, Warfarin therapeutic use
Abstract

Objectives: To compare the clinical characteristics of and use of oral anticoagulant (OAC) therapy in individuals aged 80 and older with atrial fibrillation (AF) with those of individuals younger than 80 with AF in clinical practice., Design: Observational study., Setting: The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey trial (NCT02344901), a national observational registry., Participants: Turkish adults with nonvalvular AF (NVAF)., Measurements: Age data were collected at the time of entry into the registry and the octogenarian subgroup included all patients aged ≥ 80 years. We compared background and management in octogenarian with non-octogenarian AF patients., Results: Fifty-seven cardiology units enrolled 6,273 individuals in 3 months. Participants aged 80 and older (n = 1,170) were more likely to be female (60.7% vs 54.7%, P < .001) and had a higher prevalence of persistant or permanent AF, comorbidities, history of cerebral vascular accident, and major bleeding. As a consequence of having more comorbidities, Congestive heart failure; Hypertension; Aged 75 and older; Diabetes Mellitus; prior stroke, transient ischemic attack, or thromboembolism; Vascular disease; Aged 65 to 74; female Sex (CHA 2 DS 2 VASc) (4.32 ± 1.35 vs 3.04 ± 1.54, P < .001) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile international normalized ratio, Elderly, Drugs or alcohol (HAS-BLED) (2.14 ± 1.05 vs 1.54 ± 1.05, P < .001) scores were higher in those aged 80 and older. The mean time in therapeutic range of individuals who were taking warfarin was lower in those aged 80 and older (45.9 ± 27.9) than in those younger than 80 (54.7 ± 24.9%, P < .001). Anticoagulant therapy was prescribed for 74.8% of participants younger than 80% and 63% of those aged 80 and older (P < .001). Higher CHA 2 DS 2 VASc score and lower HAS-BLED score were independent predictors of OAC prescription in participants aged 80 and older., Conclusion: Nearly one-fifth of individuals with NVAF in this real-world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual-level characteristics may explain this difference. When they were prescribed OACs, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement., (© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.)

Published
2017
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3. Guideline-adherent therapy for stroke prevention in atrial fibrillation in different health care settings: Results from RAMSES study.

Author

Başaran Ö, Dogan V, Biteker M, Karadeniz FÖ, Tekkesin Aİ, Çakıllı Y, Türkkan C, Hamidi M, Demir V, Gürsoy MO, Öztürk MT, Aksan G, Seyis S, Ballı M, Alıcı MH, Bozyel S, and Kırma C

Subjects
Administration, Oral, Aged, Aged, 80 and over, Comorbidity, Cross-Sectional Studies, Female, Humans, Logistic Models, Male, Middle Aged, Registries, Risk Factors, Tertiary Care Centers, Turkey, Anticoagulants therapeutic use, Atrial Fibrillation drug therapy, Guideline Adherence statistics & numerical data, Inappropriate Prescribing statistics & numerical data, Stroke prevention & control
Abstract

Objective: No studies have been conducted in Turkey to compare the quality of stroke prevention therapies provided in different healthcare settings in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate possible differences between secondary (SH) and tertiary hospital (TH) settings in the effectiveness of implementing AF treatment strategies., Methods: Baseline characteristics of 6273 patients with non-valvular AF enrolled in the RAMSES (ReAl-life Multicentre Survey Evaluating Stroke Prevention Strategies in Turkey) study were compared., Results: Of the study population, 3312 (52.8%) patients were treated in THs and 2961 (47.2%) patients were treated in SHs. Patients treated in the SH setting were older (70.8±9.8 vs. 68.7±11.4years, p<0.001), had a lower socioeconomic status, had a higher CHA 2 DS 2 VASc and HASBLED scores (3.4±1.4 vs. 3.1±1.7, p<0.001 and 1.7±1.0 vs. 1.6±1.1, p<0.001 respectively), and had more comorbidities than patients treated in THs. Inappropriate oral anticoagulant use was more prevalent in SHs than THs (31.4% vs. 25.6%, p<0.001). When over- and undertreatment rates were compared among hospital types, overtreatment was more prevalent in THs (7.6% vs. 0.9%, p<0.001) while undertreatment was more common in SHs (30.5% vs. 17.9%, p<0.001)., Conclusion: This study demonstrates the marked disparity between patient groups with AF presenting at SHs and THs. The use of guideline-recommended therapy is not adequate in either type of centre, overtreatment was more prevalent in THs and undertreatment was more prevalent in SHs., (Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Published
2017
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4. Impact of valvular heart disease on oral anticoagulant therapy in non-valvular atrial fibrillation: results from the RAMSES study

Author

Başaran, Özcan, Dogan, Volkan, Beton, Osman, Tekinalp, Mehmet, Aykan, Ahmet Çağrı, Kalaycıoğlu, Ezgi, Bolat, Ismail, Taşar, Onur, Şafak, Özgen, Kalçık, Macit, Yaman, Mehmet, İnci, Sinan, Altıntaş, Bernas, Kalkan, Sedat, Kırma, Cevat, Biteker, Murat, Karadeniz, Fatma Özpamuk, Tekkesin, Ahmet İlker, Çakıllı, Yasin, Türkkan, Ceyhan, Hamidi, Mehmet, Demir, Vahit, Gürsoy, Mustafa Ozan, Öztürk, Müjgan Tek, Aksan, Gökhan, Seyis, Sabri, Ballı, Mehmet, Alıcı, Mehmet Hayri, Bozyel, Serdar, Altun, Ibrahim, Çalık, Feyza, Karaca, Oğuz, Helvacı, Füsun, Akay, Kadriye, Çanga, Yiğit, Çelebi, Savaş, Altuntas, Emine, Aytürk, Mehmet, Güneş, Hacı Murat, Bezgin, Tahir, Aksakal, Aytekin, Çakal, Beytullah, Çolak, Ayşe, Kaplan, Özgür, Tatlısu, Adem, Gözübüyük, Gökhan, Demirelli, Selami, Kaya, Adnan, Rencüzoğulları, İbrahim, Bayram, Zübeyde, Şimşek, Zeki, Civan, Murat, Batgharel, Ulaankhu, Ata, Ali Ekber, Göl, Gökhan, Mert, Gurbet Özge, Mert, Kadir Ugur, Değirmencioğlu, Aleks, Candan, Özkan, Çelebi, Özlem Özcan, Doğan, Cem, Yavuz, Fethi, Ulucan, Şeref, Arısoy, Arif, Şahin, Bingül Dilekçi, Ermiş, Emrah, Gökaslan, Serkan, Pektaş, İdris, Tanındı, Aslı, Tekin, Kamuran, Sancar, Kadriye Memic, Çekiç, Edip Güvenç, Başaran, Nesrin Filiz, and and Collaborators

Published
2017
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5. Analysis of geographical variations in the epidemiology and management of non-valvular atrial fibrillation: results from the RAMSES registry

Author

Arısoy, Arif, Yavuz, Fethi, Bozyel, Serdar, Alıcı, Mehmet Hayri, Ballı, Mehmet, Seyis, Sabri, Tekkesin, Ahmet İlker, Çakıllı, Yasin, Türkkan, Ceyhan, Demir, Vahit, Çalık, Feyza, Karaca, Oğuz, Başaran, Nesrin Filiz, Çekiç, Edip Güvenç, Altun, İbrahim, Helvacı, Füsun, Aytürk, Mehmet, Akay, Kadriye, Çanga, Yiğit, Çelebi, Savaş, Altuntaş, Emine, Güneş, Hacı Murat, Bezgin, Tahir, Aksakal, Aytekin, Çakal, Beytullah, Memic Sancar, Kadriye, Çolak, AYŞE, Kaplan, Özgür, Tatlısu, Adem, Gözübüyük, Gökhan, Demirelli, Selami, Kaya, Adnan, Rencüzoğulları, İbrahim, Bayram, Zübeyde, Şimşek, Zeki, Civan, Murat, Batgharel, Ulaankhu, Başaran, Özcan, Biteker, Murat, Özpamuk Karadeniz, Fatma, Ermiş, Emrah, Dilekçi Şahin, Bingül, Ulucan, Şeref, Ata, Ali Ekber, Göl, Gökhan, Mert, Gurbet Özge, Kırma, Cevat, Aksan, Gökhan, Kalkan, Sedat, Tek Öztürk, Müjgan, Mert, Kadir Uğur, Gürsoy, Mustafa Ozan, Hamidi, Mehmet, Değirmencioğlu, Aleks, Tekin, Kamuran, Tanındı, Aslı, Pektaş, İdris, Gökaslan, Serkan, Candan, Özkan, Özcan Çelebi, Özlem, Doğan, Cem, Doğan, Volkan, Balıkesir Üniversitesi, MÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Doğan, Volkan, Başaran, Özcan, Biteker, Murat, TOBB ETU, Faculty of Medicine, Department of Internal Medical Sciences, TOBB ETÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, and Çelebi, Aksüyek Savaş

Subjects
Male, Turkish population, medicine.medical_specialty, Turkey, Epidemiology, Anticoagulant Therapy, Kalp ve Kalp Damar Sistemi, Non valvular atrial fibrillation, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Atrial Fibrillation, medicine, Humans, Black sea, 030212 general & internal medicine, Registries, Stroke, Aged, Demography, Original Investigation, Antithrombotic therapy, anticoagulant therapy, business.industry, Anticoagulants, medicine.disease, Socioeconomic Factors, Stroke prevention, Chronic Disease, Physical therapy, Observational study, Residence, Female, epidemiology, Cardiology and Cardiovascular Medicine, business, chronic disease
Abstract

Hamidi, Mehmet (Balikesir Author), Objective: This study aimed to determine the differences in terms of demographic characteristics and preferred stroke prevention strategies for patients with non-valvular atrial fibrillation living in seven geographical regions of Turkey.Methods: In total, 6273 patients were enrolled to this prospective, observational RAMSES study. The patients were divided into seven groups based on the geographical region of residence.Results: In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (1677, 26.7%). All demographic characteristics were significantly different among regions. Preferred oral anticoagulants (OACs) also differed between geographical regions; non-vitamin K OACs were preceded by warfarin in East Anatolia, Aegean, Southeast Anatolia, and Black Sea. Nearly one-third of the patients (28%) did not receive any OAC therapy. However, the number of patients not receiving any OAC therapy was higher in Southeast Anatolia (51.1%) and East Anatolia (46.8%) compared with other geographical regions of Turkey. Inappropriate use of OACs was also more common in East and Southeast Anatolia.Conclusion: This study was the first to show that the demographic differences among the geographical regions may result in different preferences of stroke prevention strategies in Turkey. OACs are still under- or inappropriately utilized, particularly in the eastern provinces of Turkey.

Published
2017

6. Real-world stroke prevention strategies in nonvalvular atrial fibrillation in patients with renal impairment

Author

Alici, Hayri, Soylu, Özcan, Altun, Ibrahim, Başaran, Filiz, Çekiç, Güvenç, Sancar, Memic, Tekin, Kamuran, Tanındı, Aslı, Pektaş, İdris, Gökaslan, Serkan, Ermiş, Emrah, Şahin, Dilekçi, Arısoy, Arif, Ulucan, Şeref, Yavuz, Fethi, Doğan, Cem, Çelebi, Özcan, Candan, Özkan, Değirmencioğlu, Aleks, Göl, Gökhan, Ata, Ekber, Batgharel, Ulaankhu, Civan, Murat, Şimşek, Zeki, Bayram, Zübeyde, Rencüzoğulları, İbrahim, Kaya, Adnan, Demirelli, Selami, Gözübüyük, Gökhan, Tatlısu, Adem, Kaplan, Özgür, Çolak, AYŞE, Çakal, Beytullah, Aksakal, Aytekin, Bezgin, Tahir, Mert, Kadir U, Mert, Gurbet Ö, Başaran, Özcan, Beton, Osman, Dogan, Volkan, Tekinalp, Mehmet, Aykan, Ahmet Ç, Kalaycıoğlu, Ezgi, Bolat, Ismail, Taşar, Onur, Şafak, Özgen, Kalçık, Macit, Yaman, Mehmet, Kırma, Cevat, Biteker, Murat, İnci, Sinan, Altıntaş, Bernas, Kalkan, Sedat, Karadeniz, Özpamuk, Tekkesin, İlker, Çakıllı, Yasin, Türkkan, Ceyhan, Hamidi, Mehmet, Demir, Vahit, Gürsoy, Ozan, Öztürk, Tek, Aksan, Gökhan, Seyis, Sabri, Ballı, Mehmet, Bozyel, Serdar, Çalık, Feyza, Karaca, Oğuz, Helvacı, Füsun, Akay, Kadriye, Çanga, Yiğit, Çelebi, Savaş, Altuntas, Emine, Aytürk, Mehmet, Güneş, Murat, [Mert, Kadir U.] Eskiehir Osmangazi Univ, Dept Cardiol, Fac Med, Eskisehir, Turkey -- [Mert, Gurbet O.] Eskisehir Yunus Emre State Hosp, Dept Cardiol, Eskisehir, Turkey -- [Basaran, Ozcan -- Dogan, Volkan -- Biteker, Murat] Mugla Sitki Kocman Univ, Dept Cardiol, Fac Med, Mugla, Turkey -- [Beton, Osman] Sivas Cumhuriyet Univ, Dept Cardiol, Fac Med, Sivas, Turkey -- [Tekinalp, Mehmet] Kahramanmaras Necip Fazil State Hosp, Dept Cardiol, Kahramanmaras, Turkey -- [Aykan, Ahmet C. -- Kalaycioglu, Ezgi] Trabzon Ahi Evren Chest Cardiovasc Surg Educ & Re, Dept Cardiol, Trabzon, Turkey -- [Bolat, Ismail] Fethiye State Hosp, Dept Cardiol, Mugla, Turkey -- [Tasar, Onur] Elazig Educ & Res Hosp, Dept Cardiol, Elazig, Turkey -- [Safak, Ozgen] Burdur State Hosp, Dept Cardiol, Burdur, Turkey -- [Kalcik, Macit] Iskilip Atif Hoca State Hosp, Dept Cardiol, Corum, Turkey -- [Yaman, Mehmet] Samsun Educ & Res Hosp, Dept Cardiol, Samsun, Turkey -- [Kirma, Cevat] Kartal Kosuyolu Heart Educ & Res Hosp, Istanbul, Turkey, BASARAN, OZCAN -- 0000-0002-6384-6455, Demir, Vahit -- 0000-0001-8349-6651, and mert, kadir ugur -- 0000-0002-1331-5365

Subjects
renal impairment, Male, medicine.medical_specialty, Clinical Biochemistry, Renal function, Administration, Oral, 030204 cardiovascular system & hematology, Biochemistry, 03 medical and health sciences, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, prevention, Fibrinolytic Agents, Internal medicine, Atrial Fibrillation, Medicine, Humans, In patient, Atrium fibrillation, 030212 general & internal medicine, Prospective Studies, Registries, Renal Insufficiency, Chronic, Stroke, Aged, glomerular filtration rate, business.industry, Anticoagulants, Atrial fibrillation, General Medicine, Baseline data, medicine.disease, stroke, Stroke prevention, Concomitant, Cardiology, Population study, Female, business, Platelet Aggregation Inhibitors, Glomerular Filtration Rate
Abstract

WOS: 000402283900004, PubMed ID: 28407216, BackgroundThe data regarding stroke prevention strategies in nonvalvular atrial fibrillation (NVAF) are limited especially in patients with renal impairment (RI). We sought to evaluate management dilemmas in patients with concurrent NVAF and RI in RAMSES (ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies inTurkey) study. MethodsWe conducted a prospective, multicenter, nation-wide registry in NVAF patients in outpatient cardiology clinics. All consecutive patients with NVAF were enrolled in RAMSES study (ClinicalTrials.gov identifier NCT02344901). The baseline data were collected. Glomerular filtration rate (GFR) was estimated by Cockcroft-Gault equation. ResultsA total number of 6273 patients from 29 provinces of Turkey with the contribution of 83 investigators were enrolled to the study. Of the study population, 1964(33%) patients had RI which was defined as GFR < 60 mL/min. Patients with RI had significantly higher CHA(2)DS(2)VASc and HAS-BLED scores compared to those without RI (39 15 vs. 29 +/- 15, and 20 +/- 1 vs. 14 +/- 1; P < 0001). Prior history of major bleeding (69% vs. 41%, P < 0001) and stroke (162% vs. 118%, P < 0001) was significantly higher among individuals with concomitant RI and NVAF. Although RI patients had a higher risk for thromboembolism, number of the patients who did not receive any anticoagulant therapy was higher in patients with RI than without RI (301 vs. 264%, P = 0003). ConclusionRAMSES study showed that one-third of the patients with NVAF had RI in the real-world setting. Although it is mandatory in most of the patients with concomitant NVAF and RI, nearly one-third of these patients did not receive any anticoagulant therapy.

Published
2017

7. Impact of valvular heart disease on oral anticoagulant therapy in non-valvular atrial fibrillation: results from the RAMSES study

Author

Tekkesin, Ahmet İlker, Öztürk, Müjgan Tek, Gürsoy, Mustafa Ozan, Demir, Vahit, Hamidi, Mehmet, Türkkan, Ceyhan, Çakıllı, Yasin, Karadeniz, Fatma Özpamuk, Biteker, Murat, Kırma, Cevat, Kalkan, Sedat, Altıntaş, Bernas, İnci, Sinan, Yaman, Mehmet, Kalçık, Macit, Şafak, Özgen, Taşar, Onur, Bolat, Ismail, Kalaycıoğlu, Ezgi, Aykan, Ahmet Çağrı, Tekinalp, Mehmet, Beton, Osman, Dogan, Volkan, Başaran, Özcan, Başaran, Nesrin Filiz, Çekiç, Edip Güvenç, Sancar, Kadriye Memic, Tekin, Kamuran, Tanındı, Aslı, Pektaş, İdris, Gökaslan, Serkan, Ermiş, Emrah, Şahin, Bingül Dilekçi, Arısoy, Arif, Ulucan, Şeref, Yavuz, Fethi, Doğan, Cem, Çelebi, Özlem Özcan, Candan, Özkan, Değirmencioğlu, Aleks, Mert, Kadir Ugur, Mert, Gurbet Özge, Göl, Gökhan, Ata, Ali Ekber, Batgharel, Ulaankhu, Civan, Murat, Şimşek, Zeki, Bayram, Zübeyde, Rencüzoğulları, İbrahim, Kaya, Adnan, Demirelli, Selami, Gözübüyük, Gökhan, Tatlısu, Adem, Kaplan, Özgür, Çolak, AYŞE, Çakal, Beytullah, Aksakal, Aytekin, Bezgin, Tahir, Güneş, Hacı Murat, Aytürk, Mehmet, Altuntas, Emine, Çelebi, Savaş, Çanga, Yiğit, Akay, Kadriye, Helvacı, Füsun, Karaca, Oğuz, Çalık, Feyza, Altun, Ibrahim, Bozyel, Serdar, Alıcı, Mehmet Hayri, Ballı, Mehmet, Seyis, Sabri, Aksan, Gökhan, [Basaran, Ozcan -- Dogan, Volkan -- Biteker, Murat] Mugla Sitki Kocman Univ, Dept Cardiol, Fac Med, Tip Fak, Orhaniye Mah Haluk Ozsoy Cad, Mugla, Turkey -- [Beton, Osman] Sivas Cumhuriyet Univ, Dept Cardiol, Fac Med, Sivas, Turkey -- [Tekinalp, Mehmet] Kahramanmaras Necip Fazil State Hosp, Dept Cardiol, Kahramanmaras, Turkey -- [Aykan, Ahmet Cagri -- Kalaycioglu, Ezgi] Trabzon Ahi Evren Chest Cardiovasc Surg Educ & Re, Dept Cardiol, Trabzon, Turkey -- [Bolat, Ismail] Fethiye State Hosp, Dept Cardiol, Mugla, Turkey -- [Tasar, Onur] Elazig Educ & Res Hosp, Dept Cardiol, Elazig, Turkey -- [Safak, Ozgen] Burdur State Hosp, Dept Cardiol, Burdur, Turkey -- [Kalcik, Macit] Iskilip Atif Hoca State Hosp, Dept Cardiol, Iskilip, Turkey -- [Yaman, Mehmet] Samsun Educ & Res Hosp, Dept Cardiol, Samsun, Turkey -- [Inci, Sinan] Aksaray State Hosp, Dept Cardiol, Aksaray, Turkey -- [Altintas, Bernas] Diyarbakir Gazi Yasargil Educ & Res Hosp, Dept Cardiol, Diyarbakir, Turkey -- [Kalkan, Sedat] Gonen State Hosp, Dept Cardiol, Gonen, Turkey -- [Kirma, Cevat] Kartal Kosuyolu Heart Educ & Res Hosp, Istanbul, Turkey, BASARAN, OZCAN -- 0000-0002-6384-6455, Demir, Vahit -- 0000-0001-8349-6651, Tıp Fakültesi, MÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Başaran, Özcan, Doğan, Volkan, and Biteker, Murat

Subjects
Male, medicine.medical_specialty, Aortic Valve Insufficiency, Heart Valve Diseases, Administration, Oral, Hemorrhage, Regurgitation (circulation), 030204 cardiovascular system & hematology, Non-valvular Atrial Fibrillation, Non-valvular atrial fibrillation, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Atrial Fibrillation, medicine, Humans, Oral Anticoagulant Therapy, cardiovascular diseases, 030212 general & internal medicine, Practice Patterns, Physicians', Stroke, Mitral regurgitation, Hematology, business.industry, ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS, valvular heart disease, Anticoagulants, Mitral Valve Insufficiency, Atrial fibrillation, Middle Aged, medicine.disease, Valvular heart disease, Surgery, ComputingMilieux_MANAGEMENTOFCOMPUTINGANDINFORMATIONSYSTEMS, Stenosis, Cross-Sectional Studies, ComputingMethodologies_PATTERNRECOGNITION, Valvular Heart Disease, cardiovascular system, Cardiology, Oral anticoagulant therapy, Population study, Female, InformationSystems_MISCELLANEOUS, Cardiology and Cardiovascular Medicine, business
Abstract

WOS: 000394997800003, PubMed ID: 27848065, The definition of non-valvular atrial fibrillation (NVAF) is controversial. We aimed to assess the impact of valvular heart disease on stroke prevention strategies in NVAF patients. The RAMSES study was a multicenter and cross-sectional study conducted on NVAF patients (ClinicalTrials.gov identifier NCT02344901). The study population was divided into patients with significant valvular disease (SVD) and non-significant valvular disease (NSVD), whether they had at least one moderate valvular disease or not. Patients with a mechanical prosthetic valve and mitral stenosis were excluded. Baseline characteristics and oral anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF, there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant valvular disease was mitral regurgitation (58.1%), followed by aortic regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had higher CHA(2)DS(2)VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0; 5.0), p < 0.001] and HAS-BLED [2.0 (1.0; 2.0) vs. 2.0 (1.0; 2.0), p = 0.004] scores compared to patients with NSVD. Overall, 2763 (71.2%) of NSVD and 1515 (73.8%) of SVD patients were on OAC therapy (p = 0.035). When the patients with SVD were analyzed separately, the mean CHA(2)DS(2)VASc and HAS-BLED scores were higher in patients with mitral regurgitation compared to patients with aortic regurgitation and aortic stenosis [4.0 (3.0; 5.0), 3.0 (2.0; 4.0), 3.0 (2.0; 4.0) p < 0.001 and 2.0 (1.0; 3.0), 1.0 (1.0; 2.0), 1.0 (0.0; 2.0) p < 0.001, respectively]. In patients with SVD, 65.7% of mitral regurgitation, 82.6% of aortic regurgitation and 88.0% of aortic stenosis patients were on OAC therapy. One out of three NVAF patients had at least one moderate valvular heart disease with the predominance of mitral regurgitation. Patients with SVD were at greater risk of stroke and bleeding compared to patients with NSVD. Although patients with mitral regurgitation should be given more aggressive anticoagulant therapy due to their higher risk of stroke, they are undertreated compared to patients with aortic valve diseases.

Published
2017

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

Author

Basaran, Ozcan, Dogan, Volkan, Beton, Osman, Tekinalp, Mehmet, Aykan, Ahmet Cagri, Kalaycioglu, Ezgi, Bolat, Ismail, Tasar, Onur, Safak, Ozgen, Kalcik, Macit, Yaman, Mehmet, Inci, Sinan, Altintas, Bernas, Kalkan, Sedat, Kirma, Cevat, Biteker, Murat, Karadeniz, Fatma Ozpamuk, Tekkesin, Ahmet Ilker, Cakilli, Yasin, Turkkan, Ceyhan, Hamidi, Mehmet, Demir, Vahit, Gursoy, Mustafa Ozan, Ozturk, Mujgan Tek, Aksan, Gokhan, Seyis, Sabri, Balli, Mehmet, Alici, Mehmet Hayri, Bozyel, Serdar, Altun, Ibrahim, Calik, Feyza, Karaca, Oguz, Helvaci, Fusun, Akay, Kadriye, Canga, Yigit, Celebi, Savas, Altuntas, Emine, Ayturk, Mehmet, Gunes, Haci Murat, Bezgin, Tahir, Aksakal, Aytekin, Cakal, Beytullah, Colak, Ayse, Kaplan, Ozgur, Tatlisu, Adem, Gozubuyuk, Gokhan, Demirelli, Selami, Kaya, Adnan, Rencuzogullari, Ibrahim, Bayram, Zubeyde, Simsek, Zeki, Civan, Murat, Batgharel, Ulaankhu, Ata, Ali Ekber, Gol, Gokhan, Mert, Gurbet Ozge, Mert, Kadir Ugur, Degirmencioglu, Aleks, Candan, Ozkan, Celebi, Ozlem Ozcan, Dogan, Cem, Yavuz, Fethi, Ulucan, Seref, Arisoy, Arif, Sahin, Bingul Dilekci, Ermis, Emrah, Gokaslan, Serkan, Pektas, Idris, Tanindi, Asli, Tekin, Kamuran, Sancar, Kadriye Memic, Cekic, Edip Guvenc, Basaran, Nesrin Filiz, Acibadem University Dspace, Basaran, Ö., Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, 48000, Turkey -- Dogan, V., Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, 48000, Turkey -- Beton, O., Department of Cardiology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey -- Tekinalp, M., Department of Cardiology, Kahramanmaras Necip Fazl State Hospital, Kahramanmaras, Turkey -- Aykan, A.C., Department of Cardiology, Trabzon Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey -- Kalaycioglu, E., Department of Cardiology, Trabzon Ahi Evren Chest Cardiovascular Surgery Education and Research Hospital, Trabzon, Turkey -- Bolat, I., Department of Cardiology, Fethiye State Hospital, Fethiye, Turkey -- Tasar, O., Department of Cardiology, Elazg Education and Research Hospital, Elazg, Turkey -- Safak, Ö., Department of Cardiology, Burdur State Hospital, Burdur, Turkey -- Kalcik, M., Department of Cardiology, Skilip Atf Hoca State Hospital, Corum, Turkey -- Yaman, M., Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey -- Nci, S., Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey -- Altintas, B., Department of Cardiology, Diyarbakr Gazi Yasargil Education and Research Hospital, Diyarbakr, Turkey -- Kalkan, S., Department of Cardiology, Gönen State Hospital, Gönen, Turkey -- Kirma, C., Kartal Kosuyolu Heart Education and Research Hospital, Kartal, Istanbul, Turkey -- Biteker, M., Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, 48000, Turkey, MÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Başaran, Özcan, Doğan, Volkan, [Karadeniz, Fatma Ozpamuk] Sanliurfa Balikligol State Hosp, Dept Cardiol, Merkez Sanliurfa, Turkey -- [Tekkesin, Ahmet Ilker -- Turkkan, Ceyhan -- Cakal, Beytullah] Siyami Ersek Heart Educ & Res Hosp, Dept Cardiol, Istanbul, Turkey -- [Cakilli, Yasin] Tuzla State Hosp, Dept Cardiol, Tuzla Istanbul, Turkey -- [Hamidi, Mehmet] Bandirma State Hosp, Dept Cardiol, Balikesir, Turkey -- [Demir, Vahit] Yozgat State Hosp, Dept Cardiol, Yozgat, Turkey -- [Gursoy, Mustafa Ozan] Gaziemir State Hosp, Dept Cardiol, Gaziemir, Turkey -- [Ozturk, Mujgan Tek -- Ayturk, Mehmet] Ankara Kecioren Educ & Res Hosp, Dept Cardiol, Ankara, Turkey -- [Aksan, Gokhan -- Helvaci, Fusun] Sisli Hamidiye Etfal Educ & Res Hosp, Dept Cardiol, Sisli, Turkey -- [Seyis, Sabri] Mersin Private Dogus Hosp, Dept Cardiol, Mersin, Turkey -- [Balli, Mehmet] Mersin Toros State Hosp, Dept Cardiol, Mersin, Turkey -- [Alici, Mehmet Hayri] Gaziantep 25 Aralik State Hosp, Dept Cardiol, Gaziantep, Turkey -- [Bozyel, Serdar] Kocaeli Derince Educ & Res Hosp, Dept Cardiol, Kocaeli, Turkey -- [Altun, Ibrahim -- Mert, Gurbet Ozge -- Mert, Kadir Ugur -- Sancar, Kadriye Memic] Mugla Sitki Kocman Univ, Fac Med, Dept Cardiol, Mugla, Turkey -- [Calik, Feyza] Mersin State Hosp, Dept Cardiol, Mersin, Turkey -- [Karaca, Oguz -- Gunes, Haci Murat] Istanbul Medipol Univ, Fac Med, Dept Cardiol, Istanbul, Turkey -- [Akay, Kadriye] Kocaeli State Hosp, Dept Cardiol, Kocaeli, Turkey -- [Canga, Yigit -- Bayram, Zubeyde -- Simsek, Zeki] Kartal Yavuz Selim State Hosp, Dept Cardiol, Istanbul, Turkey -- [Celebi, Savas] TOBB ETU Hosp, Dept Cardiol, Ankara, Turkey -- [Altuntas, Emine] Bingol State Hosp, Dept Cardiol, Bingol, Turkey -- [Bezgin, Tahir] Gebze Fatih State Hosp, Dept Cardiol, Gebze, Turkey -- [Aksakal, Aytekin] Samsun Educ & Res Hosp, Dept Cardiol, Samsun, Turkey -- [Colak, Ayse] Mut State Hosp, Dept Cardiol, Mersin, Turkey -- [Kaplan, Ozgur -- Gozubuyuk, Gokhan -- Dogan, Cem] Malatya State Hosp, Dept Cardiol, Malatya, Turkey -- [Tatlisu, Adem] Sivas Numune State Hosp, Dept Cardiol, Sivas, Turkey -- [Demirelli, Selami -- Sahin, Bingul Dilekci -- Ermis, Emrah] Erzurum Bolge Educ & Res Hosp, Dept Cardiol, Erzurum, Turkey -- [Kaya, Adnan] Suruc State Hosp, Dept Cardiol, Sanliurfa, Turkey -- [Rencuzogullari, Ibrahim] Kafkas Univ, Fac Med, Dept Cardiol, Kars, Turkey -- [Civan, Murat] Istanbul Private Liv Hosp, Dept Cardiol, Istanbul, Turkey -- [Batgharel, Ulaankhu] Acibadem Private Hosp, Dept Cardiol, Istanbul, Turkey -- [Ata, Ali Ekber] Samsun Medikal Pk Hosp, Dept Cardiol, Samsun, Turkey -- [Gol, Gokhan] Sureyyapasa Educ & Res Hosp, Dept Cardiol, Istanbul, Turkey -- [Degirmencioglu, Aleks] Istanbul Acibadem Univ, Fac Med, Dept Cardiol, Istanbul, Turkey -- [Candan, Ozkan] Usak State Hosp, Dept Cardiol, Usak, Turkey -- [Celebi, Ozlem Ozcan] Private Medicana Int Ankara Hosp, Dept Cardiol, Ankara, Turkey -- [Yavuz, Fethi] Dr Ersin Arslan State Hosp, Dept Cardiol, Gaziantep, Turkey -- [Ulucan, Seref] Mevlana Univ, Fac Med, Dept Cardiol, Konya, Turkey -- [Arisoy, Arif] Gaziosmanpasa Univ, Fac Med, Dept Cardiol, Gaziosmanpasa, Turkey -- [Gokaslan, Serkan] Istanbul Haydarpasa Numune Educ & Res Hosp, Dept Cardiol, Istanbul, Turkey -- [Pektas, Idris] Mersin Univ, Fac Med, Dept Cardiol, Mersin, Turkey -- [Tanindi, Asli] Ufuk Univ, Fac Med, Dept Cardiol, Ufuk, Turkey -- [Tekin, Kamuran] Batman Bolge State Hosp, Dept Cardiol, Batman, Turkey -- [Cekic, Edip Guvenc -- Basaran, Nesrin Filiz] Mugla Sitki Kocman Univ, Fac Med, Dept Pharmacol, Mugla, Turkey -- [Basaran, Ozcan -- Dogan, Volkan -- Biteker, Murat] Mugla Sitki Kocman Univ, Fac Med, Dept Cardiol, Mugla, Turkey -- [Beton, Osman] Sivas Cumhuriyet Univ, Dept Cardiol, Fac Med, Sivas, Turkey -- [Tekinalp, Mehmet] Kahramanmaras Necip Fazil State Hosp, Dept Cardiol, Kahramanmaras, Turkey -- [Aykan, Ahmet Cagri -- Kalaycioglu, Ezgi] Trabzon Ahi Evren Chest Cardiovasc Surg Educ & Re, Dept Cardiol, Trabzon, Turkey -- [Bolat, Ismail] Fethiye State Hosp, Dept Cardiol, Fethiye, Turkey -- [Tasar, Onur] Elazig Educ & Res Hosp, Dept Cardiol, Elazig, Turkey -- [Safak, Ozgen] Burdur State Hosp, Dept Cardiol, Burdur, Turkey -- [Kalcik, Macit] Iskilip Atif Hoca State Hosp, Dept Cardiol, Corum, Turkey -- [Yaman, Mehmet] Samsun Educ & Res Hosp, Dept Cardiol, Samsun, Turkey -- [Inci, Sinan] Aksaray State Hosp, Dept Cardiol, Aksaray, Turkey -- [Altintas, Bernas] Diyarbakir Gazi Yasargil Educ & Res Hosp, Dept Cardiol, Diyarbakir, Turkey -- [Kalkan, Sedat] Gonen State Hosp, Dept Cardiol, Gonen, Turkey -- [Kirma, Cevat] Kartal Kosuyolu Heart Educ & Res Hosp, Istanbul, Turkey, and BASARAN, OZCAN -- 0000-0002-6384-6455

Subjects
Pediatrics, Vitamin K, Turkey, Undertreatment, Administration, Oral, 030204 cardiovascular system & hematology, 0302 clinical medicine, Risk Factors, Atrial Fibrillation, atrial fibrillation, off-label use, 030212 general & internal medicine, Prospective Studies, Registries, Prospective cohort study, anticoagulation, Stroke, Over-Treatment, General Medicine, Vitamin K antagonist, stroke, ComputingMilieux_MANAGEMENTOFCOMPUTINGANDINFORMATIONSYSTEMS, Practice Guidelines as Topic, Guideline Adherence, InformationSystems_MISCELLANEOUS, medicine.drug, Research Article, medicine.medical_specialty, medicine.drug_class, Renal function, Observational Study, Subgroup analysis, Hemorrhage, Dabigatran, 03 medical and health sciences, Anticoagulation, medicine, Humans, Rivaroxaban, undertreatment, business.industry, ComputerSystemsOrganization_COMPUTER-COMMUNICATIONNETWORKS, Anticoagulants, Guideline, Off-Label Use, medicine.disease, Cross-Sectional Studies, ComputingMethodologies_PATTERNRECOGNITION, over-treatment, business
Abstract

WOS: 000384041400052, PubMed ID: 27583892, This 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

Published
2016

9. Rationale, design and methodology of the RAMSES Study: ReAl-life Multicenter Survey Evaluating Stroke Prevention Strategies

Author

Pekel, Nihat, Başaran, Özcan, Doğan, Volkan, Memic Sancar, Kadriye, Altun, İbrahim, Mert, Kadir Uğur, Mert, Gurbet Özge, Başaran, Nesrin Filiz, Çekiç, Edip Güvenç, Kırma, Cevat, Biteker, Murat, Beton, Osman, Tekinalp, Mehmet, Aykan, AhmetÇağrı, Kalaycıoğlu, Ezgi, Bolat, Ismail, Taşar, Onur, Şafak, Özgen, Kalçık, Macit, Yaman, Mehmet, İnci, Sinan, Altıntaş, Berna, Kalkan, Sedat, Özpamuk Karadeniz, Fatma, Tekkesin, Ahmetİlker, Çakıllı, Yasin, Türkkan, Ceyhan, Hamidi, Mehmet, Demir, Vahit, Gürsoy, MustafaOzan, Tek Öztürk, Müjgan, Aksan, Gökhan, Seyis, Sabri, Ballı, Mehmet, Alıcı, MehmetHayri, Bozyel, Serdar, Çalık, Feyza, Karaca, Oğuz, Helvacı, Füsun, Akay, Kadriye, Çanga, Yiğit, Çelebi, Savaş, Altuntas, Emine, Aytürk, Mehmet, Güneş, HacıMurat, Bezgin, Tahir, Aksakal, Aytekin, Çakal, Beytullah, Çolak, AYŞE, Kaplan, Özgür, Tatlısu, Adem, Gözübüyük, Gökhan, Demirelli, Selami, Kaya, Adnan, Rencüzoğulları, İbrahim, Bayram, Zübeyde, Şimşek, Zeki, Civan, Murat, Batgharel, Ulaankhu, Ata, AliEkber, Göl, Gökhan, Değirmencioğlu, Aleks, Candan, Özkan, Özcan Çelebi, Özlem, Doğan, Cem, Yavuz, Fethi, Ulucan, Şeref, Arısoy, Arif, Dilekçi Şahin, Bingül, Ermiş, Emrah, Gökaslan, Serkan, Pektaş, İdris, Tanındı, Aslı, Tekin, Kamuran, Bilal Karaayvaz, Ekrem, Koc, Mevlut, Şahin, DurmusYıldıray, Çimen, Tolga, Güvenç, TolgaSinan, Temel, Kerem, Keskin, Vehip, Soylu, MustafaÖzcan, Akın, Fatih, MÜ, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Başaran, Özcan, Doğan, Volkan, Sancar, Kadriye Memic, Altun, İbrahim, Mert, Kadir Ugur, and Mert, Gurbet Ozge

Subjects
lcsh:Internal medicine, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Turkey, Administration, Oral, lcsh:Medicine, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Atrial Fibrillation, Antithrombotic, medicine, Humans, atrial fibrillation, Prospective Studies, 030212 general & internal medicine, lcsh:RC31-1245, Prospective cohort study, oral anticoagulant, risk scores, stroke, turkey, business.industry, lcsh:R, Anticoagulants, Atrial fibrillation, Risk Scores, medicine.disease, Stroke, Anticoagulant therapy, lcsh:RC666-701, Epidemiologic Research Design, Baseline characteristics, Stroke prevention, Emergency medicine, Multicenter survey, Observational study, Oral Anticoagulant, Cardiology and Cardiovascular Medicine, business
Abstract

WOS: 000375095000005 PubMed ID: 27138310 Objective: Atrial fibrillation is the most common arrhythmia and is associated with a five-fold increased risk of thromboembolic events. Vitamin K antagonists (VKAs) have been the mainstay of oral anticoagulant prophylaxis and the data on stroke prevention strategies are limited to VKA era. The purpose of this study is to evaluate the use of VKA, non-Vitamin K antagonist oral anticoagulants (NOAC), and antiplatelet agents in patients with non-valvular atrial fibrillation (NVAF). Methods: The ReAl-life Multicenter Survey Evaluating Stroke prevention strategies in Turkey (RAMSES) is an observational, multicenter, prospective study of patients with NVAF. The study targeted enrollment of 7835 patients from 68 sites in Turkey. All the data will be collected at one point in time and current clinical practice will be evaluated. (ClinicalTrials.gov number NCT02344901). Results: Baseline characteristics of patients, antithrombotic therapies, transition to NOACs and rate/rhythm control strategies will be evaluated. Conclusion: The RAMSES registry will be the largest study in Turkish NVAF patients. The study will provide insights into real-world problems and anticoagulant treatment in patients with NVAF.

Published
2016

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