ISSN : 2146-3123
E-ISSN : 2146-3131

Geographical Variations in Patients with Heart Failure and Preserved Ejection Fraction: A Sub-Group Analysis of the APOLLON Registry
Bülent Özlek1, Eda Özlek1, Hicaz Zencirkıran Ağuş2, Mehmet Tekinalp3, Serkan Kahraman2, Oğuzhan Çelik1, Cem Çil1, Özcan Başaran1, Volkan Doğan1, Bedri Caner Kaya4, İbrahim Rencüzoğulları5, Altuğ Ösken6, Lütfü Bekar7, Mustafa Ozan Çakır8, Yunus Çelik9, Kadir Uğur Mert10, Kadriye Memiç Sancar2, Samet Sevinç2, Gurbet Özge Mert11, Murat Biteker1
1Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
2Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
3Clinic of Cardiology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
4Clinic of Cardiology, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
5Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
6Clinic of Cardiology, İstanbul Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
7Clinic of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
8Department of Cardiology, Zonguldak Bülent Ecevit Universiy School of Medicine, Zonguldak, Turkey
9Clinic of Cardiology, Yüksek İhtisas Hospital, Kırıkkale, Turkey
10Department of Cardiology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
11Clinic of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
DOI : 10.4274/balkanmedj.galenos.2019.2019.2.17
Pages : 235-244

Abstract

Background: Clinical characteristics of patients with heart failure may vary geographically. However, limited data are available regarding the geographical differences of patients with heart failure and preserved ejection fraction.
Aims: The present subgroup analysis aims to investigate the geographical differences in clinical characteristics, management, and primary etiology of patients with heart failure and preserved ejection fraction in Turkey.
Study Design: A cross-sectional study.
Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON (APOLLON) is a multicenter and observational study conducted in seven regions of Turkey (NCT03026114). The present study is a post-hoc analysis of the APOLLON registry. In this substudy, we compared the clinical characteristics of 819 consecutive patients with heart failure and preserved ejection fraction (mean age, 67 years; 57.8% women) admitted to cardiology outpatient units in different geographical regions.
Results: Based on the geographical distribution of the entire Turkish population, the highest number of patients enrolled were from Marmara (271 patients, 33.1%). All demographical characteristics, clinical and laboratory findings, comorbidities, primary etiology, and medications prescribed were significantly different between the regions. Furthermore, inter-regional gender differences were identified. Comparatively, the Aegean and Mediterranean regions had older patients with heart failure and preserved ejection fraction (p<0.001), and the Black Sea, Southeast, and East Anatolia regions had predominantly male patients (51.2, 54.5, and 56.9%, respectively; p=0.002). Notably, the Mediterranean and Southeast Anatolia had more symptomatic patients, and history of hospitalization for heart failure was more prevalent in Southeast Anatolia (33.3%, p<0.001). Prevalence of atrial fibrillation was higher in the Mediterranean and Southeast Anatolia regions (51 and 48.5%, p<0.001), and patients with heart failure and preserved ejection fraction had a higher prevalence of hypertension in the Mediterranean, Southeast Anatolia, and Black Sea regions (p=0.002). Angiotensin-converting enzyme inhibitors were more frequently prescribed in East Anatolia (52.3%, p=0.001), and the prevalence of patients with heart failure and preserved ejection fraction using loop diuretics (48.8%, p=0.003) was higher in the Black Sea region.
Conclusion: This study was the first to show geographical differences in clinical characteristics of patients with heart failure and preserved ejection fraction in Turkey. Determination of the clinical characteristics of the heart failure and preserved ejection fraction population based on the geographical region may enables physicians to adopt a region-specific clinical approach toward heart failure and preserved ejection fraction.

Keywords : Geography, heart failure, outpatients, Turkey
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