Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
Balkan Med J. 2019 Jul 11;36(4):235-244. doi: 10.4274/balkanmedj.galenos.2019.2019.2.17. Epub 2019 Apr 4.
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.
背景：心力衰竭患者的临床特征可能存在地域差异。然而，有关射血分数保留的心力衰竭患者的地域差异的数据有限。
目的：本亚组分析旨在研究土耳其射血分数保留的心力衰竭患者的临床特征、管理和主要病因的地域差异。
研究设计：这是一项横断面研究。
方法：一项全面的、观察性的心力衰竭伴中间范围和保留射血分数的登记研究（APOLLON）是在土耳其的七个地区进行的多中心观察性研究（NCT03026114）。本研究是 APOLLON 登记研究的事后分析。在本亚研究中，我们比较了在不同地理区域的心血管门诊就诊的 819 例连续心力衰竭伴射血分数保留的患者（平均年龄 67 岁，57.8%为女性）的临床特征。
结果：根据整个土耳其人口的地理分布，入组患者数量最多的是马尔马拉地区（271 例，33.1%）。所有人口统计学特征、临床和实验室发现、合并症、主要病因和开处的药物在地区间均有显著差异。此外，还发现了区域间的性别差异。相比之下，爱琴海和地中海地区的射血分数保留的心力衰竭患者年龄更大（p<0.001），黑海、东南和东安纳托利亚地区的男性患者居多（51.2%、54.5%和 56.9%，分别；p=0.002）。值得注意的是，地中海和东南安纳托利亚地区有更多症状性心力衰竭患者，并且心力衰竭住院史在东南安纳托利亚更为常见（33.3%，p<0.001）。地中海和东南安纳托利亚地区的心房颤动患病率更高（51%和 48.5%，p<0.001），地中海、东南安纳托利亚和黑海地区的射血分数保留的心力衰竭患者高血压患病率更高（p=0.002）。东安纳托利亚地区更常开血管紧张素转换酶抑制剂（52.3%，p=0.001），而黑海地区的射血分数保留的心力衰竭患者更常开袢利尿剂（48.8%，p=0.003）。
结论：本研究首次显示了土耳其射血分数保留的心力衰竭患者的临床特征存在地域差异。根据地理区域确定射血分数保留的心力衰竭人群的临床特征，可能使医生对射血分数保留的心力衰竭采用特定于区域的临床方法。
Nat Rev Cardiol. 2017-5-11
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