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Çavuşoğlu Y, Başarıcı İ, Tüfekçioğlu O, Özpelit E, Özdemir E, Sivrikoz İA, Altay H, Değertekin M, Dinçer İ, İkitimur B, Kahveci G, Bozkurt MF, Erkılıç M, Kaya GÇ, Beksaç M, Salihoğlu A, Tokgözoğlu L. Current barriers and recommendations on the diagnosis of transthyretin amyloid cardiomyopathy: a Delphi study. Front Cardiovasc Med 2024; 11:1299261. [PMID: 38333414 PMCID: PMC10851939 DOI: 10.3389/fcvm.2024.1299261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
Objectives This study has been conducted to investigate the non-invasive diagnostic journey of patients with a transthyretin amyloid cardiomyopathy (aTTR-CM) in Turkey, identify the challenges and uncertainties encountered on the path to diagnosis from the perspectives of expert physicians, and develop recommendations that can be applied in such cases. Methods This study employed a three-round modified Delphi method and included 10 cardiologists and five nuclear medicine specialists. Two hematologists also shared their expert opinions on the survey results related to hematological tests during a final face-to-face discussion. A consensus was reached when 80% or more of the panel members marked the "agree/strongly agree" or "disagree/strongly disagree" option. Results The panelists unanimously agreed that the aTTR-CM diagnosis could be established through scintigraphy (using either 99mTc-PYP, 99mTc-DPD, or 99mTc-HMPD) in a patient with suspected cardiac amyloidosis (CA) without a further investigation if AL amyloidosis is ruled out (by sFLC, SPIE and UPIE). In addition, scintigraphy imaging performed by SPECT or SPECT-CT should reveal a myocardial uptake of Grade ≥2 with a heart-to-contralateral (H/CL) ratio of ≥1.5. The cardiology panelists recommended using cardiovascular magnetic resonance (CMR) and a detailed echocardiographic scoring as a last resort before considering an endomyocardial biopsy in patients with suspected CA whose scintigraphy results were discordant/inconclusive or negative but still carried a high clinical suspicion of aTTR-CM. Conclusion The diagnostic approach for aTTR-CM should be customized based on the availability of diagnostic tools/methods in each expert clinic to achieve a timely and definitive diagnosis.
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Affiliation(s)
- Yüksel Çavuşoğlu
- Department of Cardiology, Eskisehir Osmangazi University Medical Faculty Hospital, Eskisehir, Turkey
| | - İbrahim Başarıcı
- Department of Cardiology, Akdeniz University Medical Faculty Hospital, Antalya, Turkey
| | - Omaç Tüfekçioğlu
- Department of Cardiology, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Ebru Özpelit
- Department of Cardiology, Dokuz Eylul University Medical Faculty Hospital, Izmir, Turkey
| | - Elif Özdemir
- Department of Nuclear Medicine, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - İlknur Ak Sivrikoz
- Department of Nuclear Medicine, Eskişehir Osmangazi University Medical Faculty Hospital, Eskisehir, Turkey
| | - Hakan Altay
- Department of Cardiology, Baskent University Medical Faculty Hospital, Istanbul, Turkey
| | - Muzaffer Değertekin
- Department of Cardiology, Yeditepe University Medical Faculty Hospital, Istanbul, Turkey
| | - İrem Dinçer
- Department of Cardiology, Ankara University Medical Faculty Hospital, Ankara, Turkey
| | - Barış İkitimur
- Department of Cardiology, Istanbul University Medical Faculty Hospital, Istanbul, Turkey
| | - Gökhan Kahveci
- Department of Cardiology, Başakşehir Çam Sakura City Hospital, Istanbul, Turkey
| | - Murat Fani Bozkurt
- Department of Nuclear Medicine, Hacettepe University Medical Faculty Hospital, Ankara, Turkey
| | - Metin Erkılıç
- Department of Nuclear Medicine, Akdeniz University Medical Faculty Hospital, Antalya, Turkey
| | - Gamze Çapa Kaya
- Department of Nuclear Medicine, Dokuz Eylul University Medical Faculty Hospital, Izmir, Turkey
| | - Meral Beksaç
- Department of Internal Diseases, Division of Hematology, Ankara University Medical Faculty Hospital, Ankara, Turkey
| | - Ayşe Salihoğlu
- Department of Internal Diseases, Division of Hematology, Istanbul University Medical Faculty Hospital, Istanbul, Turkey
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University Medical Faculty Hospital, Ankara, Turkey
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Cai D, Chen Q, Mu X, Xiao T, Gu Q, Wang Y, Ji Y, Sun L, Wei J, Wang Q. Development and validation of a novel combinatorial nomogram model to predict in-hospital deaths in heart failure patients. BMC Cardiovasc Disord 2024; 24:16. [PMID: 38172656 PMCID: PMC10765573 DOI: 10.1186/s12872-023-03683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The purpose of this study was to develop a Nomogram model to identify the risk of all-cause mortality during hospitalization in patients with heart failure (HF). METHODS HF patients who had been registered in the Medical Information Mart for Intensive Care (MIMIC) III and IV databases were included. The primary outcome was the occurrence of all-cause mortality during hospitalization. Two Logistic Regression models (LR1 and LR2) were developed to predict in-hospital death for HF patients from the MIMIC-IV database. The MIMIC-III database were used for model validation. The area under the receiver operating characteristic curve (AUC) was used to compare the discrimination of each model. Calibration curve was used to assess the fit of each developed models. Decision curve analysis (DCA) was used to estimate the net benefit of the predictive model. RESULTS A total of 16,908 HF patients were finally enrolled through screening, of whom 2,283 (13.5%) presented with in-hospital death. Totally, 48 variables were included and analyzed in the univariate and multifactorial regression analysis. The AUCs for the LR1 and LR2 models in the test cohort were 0.751 (95% CI: 0.735∼0.767) and 0.766 (95% CI: 0.751-0.781), respectively. Both LR models performed well in the calibration curve and DCA process. Nomogram and online risk assessment system were used as visualization of predictive models. CONCLUSION A new risk prediction tool and an online risk assessment system were developed to predict mortality in HF patients, which performed well and might be used to guide clinical practice.
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Affiliation(s)
- Dabei Cai
- Department of Cardiology, the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, Jiangsu, 213000, China
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, Liaoning, 116000, China
| | - Qianwen Chen
- Department of Cardiology, the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, Jiangsu, 213000, China
| | - Xiaobo Mu
- Department of Anesthesiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, 214023, China
| | - Tingting Xiao
- Department of Cardiology, the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, Jiangsu, 213000, China
| | - Qingqing Gu
- Department of Cardiology, the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, Jiangsu, 213000, China
| | - Yu Wang
- Department of Cardiology, the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, Jiangsu, 213000, China
| | - Yuan Ji
- Department of Cardiology, the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, Jiangsu, 213000, China
| | - Ling Sun
- Department of Cardiology, the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, Jiangsu, 213000, China.
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, Liaoning, 116000, China.
| | - Jun Wei
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, China.
| | - Qingjie Wang
- Department of Cardiology, the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, Jiangsu, 213000, China.
- Graduate School of Dalian Medical University, Dalian Medical University, Dalian, Liaoning, 116000, China.
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Şahin A, Çöllüoğlu T, Çelik A, Ata N, Yılmaz MB, Ural D, Kanık A, Ayvalı MO, Ülgü MM, Birinci Ş. Exploring Regional Disparities in Heart Failure Epidemiology and Outcomes: A Comprehensive Study Across Geographical Regions in Türkiye. Balkan Med J 2024; 41:47-53. [PMID: 38173192 PMCID: PMC10767779 DOI: 10.4274/balkanmedj.galenos.2023.2023-10-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024] Open
Abstract
Background Heart failure (HF) is a common condition that affects 1-3% of the general population. Its prevalence exhibits notable international and intranational disparities, partly explained by socioeconomic status, religion, ethnic diversity, and geographic factors. A comprehensive understanding of the epidemiological symptoms of HF in different regions of Türkiye has yet to be revealed. Aims To examine epidemiological data from 2016 to 2022, focusing on crucial patient characteristics and geographical regions, to determine the incidence and prevalence of HF in Türkiye across seven diverse geographical regions. Study Design A nationwide population-based retrospective cohort study. Methods The comprehensive National Electronic Database of the Turkish Ministry of Health was used in this study to obtain data that covers the whole Turkish population from January 1, 2016, to December 31, 2022. The International Classification of Diseases-10 (ICD-10) codes were used to identify adults with HF (n = 2,701,099) and associated comorbidities. Türkiye is divided into seven geographically distinct regions. Epidemiological characteristics and survival data of these regions were analyzed separately. All-cause mortality was set as the primary outcome. Results In , the total estimated prevalence of adult patients with HF is 2.939%, ranging from 2.442% in Southeastern Anatolia to 4.382% in the Black Sea Region. Except for the Eastern Anatolia Region, the three most often reported comorbidities were hypertension, dyslipidemia, and anxiety disorders. The rates of prescribing guideline-directed medical therapy (GDMT) for HF and other medications varied significantly. GDMT prescription rates were lowest in the Eastern Anatolia Region (82.6% for beta-blockers, 48.7% for RASi, 31.8% for mineralocorticoid receptor antagonists, and 9.4% for SGLT2i). The Mediterranean and Aegean regions had the highest median N-terminal brain natriuretic peptide (NT-proBNP) levels of 1,990,0 pg/ml (518.0-6,636,0) and 1,441,0 pg/ml (363.0-5,000,0), respectively. From 2016 to 2022, 915,897 (33.9%) of 2,701,099 patients died. The Eastern Anatolia Region had the lowest all-cause mortality rate of 26.5%, whereas the Black Sea Region had the highest all-cause mortality rate of 35.3%. Conclusion Our real-world analysis revealed geographic disparities in HF characteristics, such as decreased mortality in socioeconomically challenged regions. Higher stress susceptibility in developed regions may increase the likelihood of adverse outcomes.
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Affiliation(s)
- Anıl Şahin
- Department of Cardiology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
| | - Tuğçe Çöllüoğlu
- Department of Cardiology, Karabük University Faculty of Medicine, Karabük, Türkiye
| | - Ahmet Çelik
- Department of Cardiology, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - Naim Ata
- General Directorate of Health Information Systems, Ministry of Health, Ankara, Türkiye
| | - Mehmet Birhan Yılmaz
- Department of Cardiology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Dilek Ural
- Department of Cardiology, Koç University Faculty of Medicine, Mersin, Türkiye
| | - Arzu Kanık
- Department of Biostatistics and Medical Informatics, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - Mustafa Okan Ayvalı
- General Directorate of Health Information Systems, Ministry of Health, Ankara, Türkiye
| | - Mustafa Mahir Ülgü
- General Directorate of Health Information Systems, Ministry of Health, Ankara, Türkiye
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Skouri HN, Çavuşoğlu Y, Bennis A, Klug E, Ogola EN, Bader F, Bahjet Al Saffar H, Ragy H, Alhumood KA, Abdelhamid M, Birhan Yılmaz M, Tabbalat R. Expert Recommendations to Bridge Gaps in Heart Failure Patient Support in the Middle East and Africa Region. Anatol J Cardiol 2024; 28:2-18. [PMID: 38167796 PMCID: PMC10796245 DOI: 10.14744/anatoljcardiol.2023.3517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/18/2023] [Indexed: 01/05/2024] Open
Abstract
Heart failure (HF) remains a serious health and socioeconomic problem in the Middle East and Africa (MEA). The age-standardized prevalence rate for HF in the MEA region is higher compared to countries in Eastern Europe, Latin America, and Southeast Asia. Also cardiovascular-related deaths remain high compared to their global counterparts. Moreover, in MEA, 66% of HF readmissions are elicited by potentially preventable factors, including delay in seeking medical attention, nonadherence to HF medication, suboptimal discharge planning, inadequate follow-up, and poor social support. Patient support in the form of activation, counseling, and caregiver education has been shown to improve outcomes in patients with HF. A multidisciplinary meeting with experts from different countries across the MEA region was convened to identify the current gaps and unmet needs for patient support for HF in the region. The panel provided insights into the real-world challenges in HF patient support and contributed strategic recommendations for optimizing HF care.
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Affiliation(s)
- Hadi N. Skouri
- Department of Cardiology, Sheikh Shakbout Medical City-Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Yüksel Çavuşoğlu
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye
| | - Ahmed Bennis
- Department of Cardiology, The Ibn Rochd University Hospital Center, Casablanca, Morocco
| | - Eric Klug
- Division of Cardiology, Netcare Sunninghill, Sunward Park Hospitals, School of Clinical Medicine, Faculty of Health Sciences and the University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Elijah N. Ogola
- Department of Internal Medicine and Cardiology, University of Nairobi, Nairobi, Kenya
| | - Feras Bader
- Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Section of Heart Failure and Transplant, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Hilal Bahjet Al Saffar
- International Advisor, RCP for Iraq, Chair, RCP Iraq Members and Fellows Network Head, Scientific Committee, Iraqi Red Crescent Society Iraq, Baghdad, Iraq
| | - Hany Ragy
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Khaldoon A. Alhumood
- Advanced Heart Failure and Transplantation Unit, Chest Diseases Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Magdy Abdelhamid
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mehmet Birhan Yılmaz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
| | - Ramzi Tabbalat
- Department of Cardiology, Abdali Medical Center, Amman, Jordan
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Kapelios CJ, Shahim B, Lund LH, Savarese G. Epidemiology, Clinical Characteristics and Cause-specific Outcomes in Heart Failure with Preserved Ejection Fraction. Card Fail Rev 2023; 9:e14. [PMID: 38020671 PMCID: PMC10680134 DOI: 10.15420/cfr.2023.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/15/2023] [Indexed: 12/01/2023] Open
Abstract
Heart failure (HF) is a global pandemic affecting 64 million people worldwide. HF with preserved ejection fraction (HFpEF) has traditionally received less attention than its main counterpart, HF with reduced ejection fraction (HFrEF). The incidence and prevalence of HFpEF show geographic variation and are increasing over time, soon expected to surpass those of HFrEF. Morbidity and mortality rates of HFpEF are considerable, albeit lower than those of HFrEF. This review focuses on the burden of HFpEF, providing contemporary data on epidemiology, clinical characteristics and comorbidities, cause-specific outcomes, costs and pharmacotherapy.
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Affiliation(s)
- Chris J Kapelios
- Department of Cardiovascular Medicine, University of Utah Health Sciences CenterSalt Lake City, UT, US
| | - Bahira Shahim
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
| | - Gianluigi Savarese
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholm, Sweden
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Escobar C, Palacios B, Varela L, Gutiérrez M, Duong M, Chen H, Justo N, Cid-Ruzafa J, Hernández I, Hunt PR, Delgado JF. Healthcare resource utilization and costs among patients with heart failure with preserved, mildly reduced, and reduced ejection fraction in Spain. BMC Health Serv Res 2022; 22:1241. [PMID: 36209120 PMCID: PMC9547468 DOI: 10.1186/s12913-022-08614-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS To describe healthcare resource utilization (HCRU) of patients with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF) in Spain. METHODS: Adults with ≥ 1 HF diagnosis and ≥ 1 year of continuous enrolment before the corresponding index date (1/January/2016) were identified through the BIG-PAC database. Rate per 100 person-years of all-cause and HF-related HCRU during the year after the index date were estimated using bootstrapping with replacement. RESULTS Twenty-one thousand two hundred ninety-seven patients were included, of whom 48.5% had HFrEF, 38.6% HFpEF and 4.2% HFmrEF, with the rest being of unknown EF. Mean age was 78.8 ± 11.8 years, 53.0% were men and 83.0% were in NYHA functional class II/III. At index, 67.3% of patients were taking renin angiotensin system inhibitors, 61.2% beta blockers, 23.4% aldosterone antagonists and 5.2% SGLT2 inhibitors. Rates of HF-related outpatient visits and hospitalization were 968.8 and 51.6 per 100 person-years, respectively. Overall, 31.23% of patients were hospitalized, mainly because of HF (87.88% of total hospitalizations); HF hospitalization length 21.06 ± 17.49 days (median 16; 25th, 75th percentile 9-27). HF hospitalizations were the main cost component: inpatient 73.64%, pharmacy 9.67%, outpatient 9.43%, and indirect cost 7.25%. Rates of all-cause and HF-related HCRU and healthcare cost were substantial across all HF subgroups, being higher among HFrEF compared to HFmrEF and HFpEF patients. CONCLUSIONS HCRU and cost associated with HF are high in Spain, HF hospitalizations being the main determinant. Medication cost represented only a small proportion of total costs, suggesting that an optimization of HF therapy may reduce HF burden.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, University Hospital La Paz, Madrid, Spain
| | | | | | | | | | | | - Nahila Justo
- Evidera, Stockholm, Sweden; Karolinska Institute, Department of Neurobiology, Care Sciences, and Society, Stockholm, Sweden
| | | | | | | | - Juan F Delgado
- Cardiology Department, University Hospital 12 de Octubre, CIBERCV, Madrid, Spain.
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