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

Geographic Variations in Patients with Heart Failure and Preserved Ejection Fraction: A Sub-Group Analysis of 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 Mert3,11, Murat Biteker1
1Department of Cardiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
2Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
3Department of Cardiology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey
4Department of Cardiology, Mehmet Akif İnan Training and Research Hospital, Sanlıurfa, Turkey
5Department of Cardiology, Kafkas University, Faculty of Medicine, Kars, Turkey
6Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
7Department of Cardiology, Hitit University Corum Erol Olcok Training and Research Hospital, Corum, Turkey
8Department of Cardiology, Bulent Ecevit Universiy, Faculty of Medicine, Zonguldak, Turkey
9Department of Cardiology, Kirikkale Yuksek İhtisas Hospital, Kirikkale, Turkey
10Department of Cardiology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
11Department of Cardiology, Yunus Emre State Hospital, Eskisehir, Turkey
DOI : 10.4274/balkanmedj.galenos.2019.2019.2.17

Background: Clinical features of patients with heart failure (HF) may vary by geographical region. However, the available data on the geographic differences of patients with heart failure and preserved ejection fraction (HFpEF) are limited.
Aims: The present subgroup analysis aims to investigate the geographical differences in clinical characteristics, management, and leading etiology of patients with HFpEF in Turkey.
Study Design: Cross-sectional study.
Methods: APOLLON (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is a multicenter and observational study conducted in seven regions of Turkey (NCT03026114). This study is a post-hoc analysis of APOLLON registry. Consecutive 819 patients (mean age of 67 years, 57.8% women) admitted to the cardiology outpatient units with HFpEF were included in this substudy and clinical characteristics of patients in different geographic regions were compared.
Results: In terms of the geographical distribution of the overall Turkish population, the highest number of patients were enrolled from Marmara (271 patients, 33.1%). All demographic characteristics, clinical and laboratory findings, comorbidities, leading etiology and prescribed medications were significantly different between regions. Also, gender differences identified between geographic regions. Compared to the other regions, those with HFpEF patients were older in the Aegean and Mediterranean regions (p<0.001), and were more likely to be male in Black Sea, Southeast and East Anatolia (51.2, 54.5 and 56.9%, respectively; p=0.002). Patients in Mediterranean and Southeast Anatolia were more symptomatic and history of hospitalization for HF were also more common in the Southeast Anatolia (33.3%, p<0.001). Prevalence of atrial fibrillation was higher in the Mediterranean and Southeast Anatolia (51 and 48.5%, p<0.001) regions, and HFpEF patients had higher prevalence of hypertension in Mediterranean, Southeast Anatolia and Black Sea (p=0.002). Angiotensin-converting enzyme inhibitors were more frequently prescribed in East Anatolia (52.3%, p=0.001), and HFpEF patients were more likely to use loop diuretics (48.8%, p=0.003) in the Black Sea region.
Conclusions: This study was the first to show that clinical characteristics differences between geographical regions in patients with HFpEF in Turkey. Determination of the clinical features of HFpEF population by region, may contribute clinically facilitate to physicians’ on approach to HFpEF in different regions.

Keywords : Geography; heart failure; outpatients; Turkey
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