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"Latar belakang: Gagal Jantung Dekompensasi Akut (GJDA) merupakan penyebab utama terjadinya kematian dan kesakitan di dunia. Angka kematian dalam perawatan di dunia adalah sebesar 3-4%, sementara di Indonesia sebesar 11,2% berdasarkan Indonesian Registry of Heart Failure. Tatalaksana menggunakan diuretik loop telah dibuktikan efektif dalam meredakan kongesti, namun penggunaan secara terus menerus dapat menyebabkan terjadinya komplikasi berupa resistensi diuretik. Resistensi diuretik terjadi pada 20-35% pasien dengan GJDA dan telah diketahui sebagai prediktor independen terhadap terjadinya perburukan luaran klinis, kematian segera paska perawatan dan kejadian rawat ulang. Tujuan: Mengetahui faktor-faktor yang mempengaruhi terjadinya resistensi diuretik pada pasien GJDA brdasarkan penyakit yang mendasari, komorbid, tanda vital, fraksi ejeksi ventrikel kiri dan laboratorium.Metode: Studi kohort retrospektif dilakukan pada 535 pasien yang dirawat dengan GJDA selama periode Januari-Desember 2019. Resistensi diuretik didefinisikan sebagai respon diuresis kurang dari 1400ml dalam 24jam pertama setelah pemberian 40mg furosemide intravena (atau setara).Hasil: Resistensi diuretik terjadi pada 68% pasien. Prediktor independen terhadap terjadinya resistensi diuretik yang diperoleh dari analisa regresi logistik multivariat adalah: riwayat DM (p = 0.013), riwayat penggunaan diuretik loop iv > 6 hari (p = 0.002), dosis diuretik loop oral > 80mg/hari (p = 0.006), FEVKi ≤ 49% (p = 0.002), BUN ≥ 21 mg/dL (p < 0.001) dan klorida serum < 98mmol/L (p < 0.001). Sebagai tambahan, sebuah sistem skoring telah dibuat berdasarkan model akhir tersebut.Kesimpulan: Kejadian resistensi diuretik dapat diprediksi berdasarkan karakteristik pasien, parameter klinis dan laboratorium. Sistem skoring baru dapat memprediksi kejadian resistensi diuretik pada pasien gagal jantung dekompensasi akut yang menjalani rawat inap.

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Background: Acute Decompensated Heart failure (ADHF) is a leading cause of mortality and morbidity in the world. In-hospital mortality rate is 3-4%, while in Indonesia it is 11.2% based on the Indonesian Heart Failure Registry. The management of using loop diuretics has proven effective in relieving congestion yet continuous utilization could lead to the development of diuretic resistance. Diuretic resistance occurs in 20-35% of patients with ADHF and has been shown to be an independent predictor of worsening clinical outcomes, immediate post-treatment death and re-admission events.

Objective: to identify factors that influence the occurrence of diuretic resistance in ADHF patients based on the underlying disease, comorbidities, vital signs, left ventricular ejection fraction and laboratory.

Methods: A cohort retrospective study was conducted on 535 patients treated with ADHF from January-December 2019. Diuretic resistance was defined as a diuresis response of less than 1400ml in the first 24 hours after administration of 40mg of intravenous furosemide (or equivalent).

Results: Diuretic resistance occurs in 68% of patients. Independent predictors obtained from multivariate logistic regression analysis were: history of DM (p = 0.013), history of using iv loop diuretics > 6 days (p = 0.002), oral loop diuretic dose > 80mg/day (p = 0.006), LVEF ≤ 49% (p = 0.002), BUN ≥ 21 mg/dL (p < 0.001)and serum chloride <98mmol/L (p <0.001). In addition, a scoring system has been made from the final model.

Conclusion: Diuretic resistance could be predicted using patient's characteristics, clinical parameters and laboratory findings. A new scoring system could predict diuretic resistance among patients hospitalized with acute decompensated heart failure. "

"Latar belakang: Pasien gagal jantung dengan penurunan fraksi ejeksi memiliki angka readmisi yang lebih tinggi dibandingkan dengan fraksi ejeksi normal, dan angka readmisi paling tinggi pada 30-hari pertama pascakeluar admisi sebelumnya. Sekitar 30% pasien dengan gagal jantung juga mengalami Diabetes Melitus (DM) Tipe-2. Sejauh ini, belum ada prediktor kejadian readmisi dalam 30-hari pada pasien dengan populasi tersebut di RSJPDHK, khususnya prediktor dari sisi klinis dan metabolik.Tujuan: Mengetahui prediktor klinis dan metabolik terhadap kejadian readmisi dalam 30-hari pada pasien Gagal Jantung Dekompensasi Akut (GJDA) dengan penurunan fraksi ejeksi dan DM tipe-2.Metode: Studi dilakukan secara kohort retrospektif, data diambil dari rekam medis berdasarkan admisi pasien yang memenuhi kriteria inklusi antara Januari 2016-Januari 2021. Luaran klinis terbagi menjadi kelompok readmisi dan kelompok non-readmisi. Luaran klinis yang dinilai adalah kejadian readmisi akibat perburukan kondisi gagal jantung pada 30-hari pascaadmisi terakhir di RSJPDHK. Dilakukan analisis multivariat untuk menentukan prediktor yang bermakna menentukan readmisi dalam 30-hariHasil: Dari total 747 subjek penelitian, 179 subjek termasuk ke dalam kelompok readmisi, dan 568 subjek termasuk ke dalam kelompok non-readmisi (angka readmisi 24%). Analisis regresi logistik multivariat menunjukkan bahwa faktor-faktor yang berhubungan dengan kejadian readmisi dalam 30-hari adalah: irama fibrilasi atrium (OR 2.616; 95% IK: 1.604-4.267; p 0.000), serta denyut jantung saat pulang rawat (OR 1.022; 95% IK: 1.005-1.039; p 0.010). Kadar gula darah post-prandial < 140 mg/dL menjadi prediktor protektif untuk kejadian readmisi dalam 30-hari (OR 0.528; 95% IK: 0.348-0.802; p 0.003).Kesimpulan: Dua faktor klinis yaitu irama fibrilasi atrium dan denyut jantung saat akhir masa rawat menjadi prediktor readmisi yang bermakna terhadap kejadian readmisi dalam 30-hari akibat perburukan kondisi gagal jantung, sedangkan kadar gula darah post-prandial < 140 mg/dL menjadi faktor protektif untuk kejadian readmisi 30-hari pada populasi pasien gagal jantung dengan penurunan fraksi ejeksi dan DM tipe-2.

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Background: Patients Heart Failure with reduced Ejection Fraction (HFrEF) had higher readmission rates than normal ejection fractions, and readmission rates were highest in the first 30-days post-admission. About 30% of patients with heart failure also have Type-2 Diabetes Mellitus (DM). So far, there is no predictors for the incidence of 30-days readmission in patients with this kind of population in National Cardiovascular Centre Harapan Kita (NCCHK).

Objective: To determine the clinical and metabolic predictors of 30-days readmission in patients with Acute Decompensated Heart Failure (ADHF) with reduced ejection fraction and type-2 DM.

Methods: The study was conducted in a retrospective-cohort, data were taken from medical records based on admissions of patients who met the inclusion criteria between January 2016-January 2021. The clinical outcomes were divided into readmission and non-readmission groups. The clinical outcome assessed was the incidence of readmission due to worsening of the condition of heart failure at 30-days after the last admission at NCCHK. Multivariate analysis was performed to determine significant predictors for 30-day readmission.

Result: Of the total 747 research subjects, 179 subjects were included in the readmission group, and 568 subjects included in the non-readmission group (readmission rate 24%). Multivariate logistic regression analysis showed that the factors associated at 30-days readmission were: atrial fibrillation rhythm (OR 2.616; 95% CI: 1.604-4,267; p 0.000), heart rate at discharge (OR 1.022; 95% CI: 1.005-1.039; p 0.010). Post-prandial blood glucose level < 140 mg/dL was a protective predictor for 30-day readmission (OR 0.528; 95% CI: 0.348-0.802; p 0.003).

Conclusions: Two clinical factors, namely atrial fibrillation and heart rate at the end of hospitalization, were significant predictors of readmission in 30 days due to worsening of heart failure, while postprandial blood sugar levels < 140 mg/dL were protective factors for 30-days readmission in population of heart failure with reduced ejection fraction and type-2 DM."

"ABSTRAKLatar Belakang: Prevalensi gagal jantung semakin meningkat per tahun, 60-70% disebabkan penyakit jantung koroner (PJK). Beberapa faktor risiko penyebab gagal jantung yaitu DM, hipertensi, obesitas, sindrom metabolik, dan aterosklerosis. Patofisologi gagal jantung sangat kompleks dan melibatkan banyak sistem, terjadi hipermetabolisme yang dapat menyebabkan penurunanberat badan dan memicu terjadinya malnutrisi. Keadaan gagal jantung dekompensasi akut karena infark miokard lama membutuhkan penanganan segera di RS untuk menghindari komplikasi lebih lanjut.Metode: Laporan serial kasus ini memaparkan empat kasus pasien gagal jantung dekompensasi akut karena infark miokard lama, berusia antara 41 hingga 70 tahun, dan tiga diantaranya dengan riwayat DM tipe II. Semua pasien memerlukan dukungan nutrisi, tiga pasien memiliki status gizi obesitas dan satu pasien berat badan normal. Masalah berkaitan erat pada nutrisi keempat pasien adalah hipoalbuminemia, gangguan elektrolit, gangguan fungsi ginjal, gangguan fungsi hati, keseimbangan cairan, serta defisiensi mikronutrien. Perhitungan kebutuhan energi basal (KEB) dihitung berdasarkan rumus Harris Benedict dengan faktor stres sesuai kondisi klinis dan penyakit penyerta. Komposisi makronutrien diberikan menurutrekomendasi Therapeutic Lifestyle Changes (TLC) dan American Heart Association (AHA), pemberian protein disesuaikan dengan fungsi ginjal masing-masing pasien. Pemberian suplementasi mikronutrien juga diberikankepada keempat pasien. Pemantauan pasien meliputi keluhan subyektif, hemodinamik, analisis toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan dan kapasitas fungsional.Hasil: pemantauan selama di RS, keempat pasien menunjukkan perbaikan klinis, peningkatan toleransi asupan, perbaikan kadar elektrolit dan peningkatan kapasitas fungsional.Kesimpulan: Terapi nutrisi medik yang adekuat dapat memperbaiki kondisi klinis pasien gagal jantung dekompensasi akut karena infark miokard lama.

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ABSTRACT

Background: The prevalence of heart failure increase annually, 60-70% due to coronary heart disease (CHD). Some of the risk factors associated with heart failure are diabetes, hypertension, obesity, metabolic syndrome, and atherosclerosis. The phatophysiology of heart failure is very complex and involves many systems. The occurance of hypermetabolism can lead to weight loss and triger malnutrition. The state of acute decompensated heart failure due to old myocardial infarction require immediate treatment in hospital to avoid further complications.

Methods: This series of case report describes four cases of patients with acute myocardial heart failure, due to old infarction, aged between 41 to 70 years old, and three of them with a history of type 2 diabetes melitus. All patients required nutritional support, three patients had nutritional status of obese and one patient was normal in weight. The problems which closely linked to all nutrition of the four patients were hypoalbuminemia, electrolyte disturbances, impaired renal function, impaired liver function, fluid inbalance, and micronutrient deficiencies. Basal Energy Requirement was calculated using Harris Benedict formula with stress factors corresponding clinical condition and comorbidities. Macronutrients composition was given according to the recommendation of the Therapeutic Lifestyle Changes (TLC) and the American Heart Association (AHA), while the provision of proteins was

tailored with the kidney function of each patient. Micronutrients supplementation was also given to four patients. Patient monitoring parameters included subjective complaints, hemodynamic, analysis tolerance

of intake, laboratory tests, anthropometric, fluid balance and functional capacity.

Results: During the monitoring period in the hospital four patients showed clinical improvement, increased tolerance of intake, improved electrolyte levels and increased functional capacity.

Conclusion:Adequate medical nutrition therapy can improve the clinical condition of patients with acute decompensated heart failure due to old myocardial infarction."

"Latar Belakang: Beberapa penelitian telah menunjukkan bahwa hipokloremia berhubungan dengan peningkatan rehospitalisasi dan mortalitas pada pasien dengan gagal jantung (chloride hypothesis). Akan tetapi, penelitian-penelitian tersebut hanya membandingkan kelompok pasien gagal jantung dengan hipokloremia dengan kelompok normokloremia saat admisi. Tujuan: Mengetahui pengaruh normalisasi kadar klorida terhadap rehospitalisasi dan mortalitas pasien gagal jantung. Metode: Dilakukan penelitian kohort prospektif pasien gagal jantung dekompensasi akut (GJDA) yang dirawat inap dari September 2018 sampai Februari 2019. Pasien dengan hipokloremia dan normonatremia saat admisi dibagi menjadi kelompok hipokloremia persisten hingga saat pemulangan dibanding kelompok normokloremia saat pemulangan. Luaran primer adalah rehospitalisasi karena gagal jantung dalam 180 hari. Luaran sekunder adalah mortalitas dalam 180 hari. Hasil: Terdapat 162 pasien (53,6%) yang termasuk dalam kelompok hipokloremia persisten dan 140 pasien (46,3%) yang termasuk dalam kelompok normokloremia saat pemulangan. Model regresi Cox menunjukkan hipokloremia persisten tidak berkaitan bermakna dengan peningkatan rehospitalisasi karena gagal jantung (hazard ratio 1,21; interval kepercayaan 95% 0,78-1,89; p 0,392) dan mortalitas (hazard ratio 1,39; interval kepercayaan 95% 0,74-2,65; p 0,305) dibandingkan dengan kelompok normokloremia saat pemulangan. Kesimpulan: Hipokloremia persisten pada pasien GJDA bukan merupakan prediktor independen terhadap rehospitalisasi gagal jantung dan mortalitas.

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Background: Recent studies have shown that hypochloremia is associated with increased risk of rehospitalization and death in patients with heart failure (chloride hypothesis). In these studies, however, patients with hypochloremia were compared only with patients with a normal chloride level at hospital admission. Aim: To evaluate the effect of the normalization of serum chloride on the heart failure to rehospitalization and mortality. Method: This was a prospective cohort study of patients hospitalized for acute decompensated heart failure (ADHF) from September 2018 to February 2019. Patients with hypochloremia and normonatremia at admission were divided into patients with persistent hypochloremia at the time of discharge and patients who achieved normalization of their serum chloride levels at discharge. The primary outcome was 180-day rehospitalization. The secondary outcome was 180-day mortality.

Results: There were 162 patients (53,6%) with persistent hypochloremia and 140 patients (46,3%) with normochloremia at discharge. Cox regression model indicated persistent hypochloremia did not significantly predict heart failure rehospitalisation (hazard ratio 1.21; 95% confidence interval 0.78-1.89; p 0.392) and mortality (hazard ratio 1.39; 95% confidence interval 0.74-2.65; p 0.305) compared with group of normochloremia at discharge.

Conclusion: Persistent hypochloremia in ADHF patients is not an independent predictor of heart failure rehospitalisation and mortality."

"Latar belakang: Di Indonesia gagal jantung telah menjadi masalah utama komunitas karena tingginya biaya perawatan, kualitas hidup yang rendah, dan kematian prematur. Hingga saat ini loop diuretic masih merupakan terapi utama pada pasien gagal jantung dekompensasi akut (GJDA) dengan klinis kongesti. Respon diuresis dapat diukur secara objektif melalui pengukuran natrium urin. Natrium urin yang rendah atau tetap rendah setelah pemberian loop diuretic dapat menunjukkan derajat gagal jantung yang lebih berat. Penelitian ini bertujuan untuk mengetahui respon natriuresis 2 jam paska pemberian loop diuretic serta hubungannya terhadap lama masa rawat dan rawat ulang dalam 30 hari.Metode: Dilakukan pengukuran kadar natrium dalam urin sebelum dan 2 jam paska pemberian loop diuretic pada pasien gagal jantung dekompensasi akut, lalu diobservasi lama masa rawat dan kejadian rawat ulang dalam 30 hari paska rawat pada masing-masing kelompok kadar natrium urin rendah dan kadar natrium urin tinggi.Hasil: Dari 51 pasien yang diuji, rerata usia adalah 52.62 ± 13.72 tahun, mayoritas laki-laki (78.4%). Mayoritas sampel juga menerima obat-obatan gagal jantung selama perawatan. Sebanyak 40 (78,4%) orang menerima obat gagal jantung golongan ACE inhibitor/ARB dan 36 (70,4%) orang menerima obat golongan beta-blocker. Kadar natrium urin 2 jam pasca pemberian loop diuretic berkorelasi moderat dengan lama masa rawat yang semakin singkat (p< 0.05), ditemukan perbedaan signifikan dengan median lama masa rawat pada kelompok tingkat natrium rendah selama 7 (IQR 4 – 11) hari dan pada kelompok natrium tinggi selama 5 (IQR 2,25 – 6) hari. Sedangkan hubungan tingkat kadar natrium urin 2 jam pasca pemberian loop diuretic dengan rawat ulang dalam 30 hari tidak ditemukan perbedaan hubungan bermakna antara kedua variabel ini. Terdapat hubungan bermakna (p < 0,05) antara pengobatan beta-blocker dan ACE inhibitor/ARB rawat ulang dalam 30 hari. Pengobatan beta-blocker dan ACE inhibitor/ARB mengurangi risiko rawat ulang.Kesimpulan: Terdapat hubungan antara kadar natrium urin 2 jam paska loop diuretic dengan lama masa rawat, dimana kadar natrium rendah memiliki lama masa rawat lebih panjang. Meskipun demikian, hal tersebut tidak berhubungan dengan kejadian rawat ulang dalam 30 hari.

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Background: In Indonesia, heart failure has become a major community problem because of the high cost of care, low quality of life, and premature death. Until now, loop diuretics are still the main therapy in patients with acute decompensated heart failure (ADHF) with clinical congestion. Diuresis responsiveness can be measured objectively by measuring sodium urine. Low sodium urine or remains low after loop diuretic administration may indicate a more severe degree of heart failure.This study aims to determine the response of natriuresis 2 hours after loop diuretic administration and its relationship to length of stay and readmission in 30 days.

Result: Among the 51 patients tested, the mean age was 52.62 ± 13.72 years, the majority were men (78.4%). The majority of the samples received heart failure drugs during treatment. A total of 40 (78.4%) people received ACE inhibitors/ARB and 36 (70.4%) received beta-blockers. Urinary sodium level 2 hours after loop diuretic administration was moderately correlated with shorter length of stay (p < 0.05), a significant difference was found with the median length of stay in the low sodium level group for 7 (IQR 4 – 11) days and in the sodium group. high for 5 (IQR 2.25 – 6) days. Meanwhile, the relationship between urinary sodium levels 2 hours after loop diuretic administration and hospitalization within 30 days was not found to be significantly different between these two variables. There was a significant relationship (p < 0.05) between beta-blocker and ACE inhibitors/ARB treatment and re-admission within 30 days. Beta-blocker and ACE inhibitors/ARB treatment reduced the risk of readmission.

Conclusion: There is a relationship between urinary sodium levels 2 hours after loop diuretic and length of stay, where low sodium levels have a longer length of stay. However, it is not related to the readmission incidence within 30 days"

"Latar belakang: Pasien gagal jantung sering mengalami readmisi dengan tingkat mortalitas yang tinggi sehingga diperlukan deteksi dini dan tatalaksana yang tepat untuk memperbaiki prognosis. Resiko rawat inap akibat gagal jantung bahkan lebih meningkat pada pasien diabetes mellitus (DM) tipe 2, yaitu 1.5x lebih tinggi. Menggunakan kecerdasan buatan, dapat dilakukan integrasi antara data klinis dengan pemeriksaan penunjang seperti EKG dan rontgen thorax. Selain itu, kecerdasan buatan juga dapat membantu diagnosis di bidang kardiovaskular tanpa adanya variabilitas antar pengamat, serta meningkatkan efisiensi waktu dan biaya.Tujuan: Penelitian ini bertujuan untuk membandingkan kemampuan kecerdasan buatan dengan statistik konvensional dalam memprediksi luaran klinis lama rawat, readmisi 30 hari, mortalitas 180 hari, dan luaran gabungan pada pasien gagal jantung dekompensasi akut (GJDA) dengan penurunan fraksi ejeksi dan DM tipe 2.Metode: Dilakukan studi kohort retrospektif terhadap pasien GJDA dengan penurunan fraksi ejeksi dan DM tipe 2 pada periode Januari 2018 – Maret 2023. Dilakukan analisis data menggunakan statistik konvensional dengan analisis bivariat dan multivariat, dimana hasilnya kemudian dibandingkan dengan analisis menggunakan algoritme kecerdasan buatan, yaitu Balanced Random Forest.Hasil: Melalui rekam medis, didapatkan 292 subjek penelitian dengan persentase lama rawat >5 hari, readmisi 30 hari, mortalitas 180 hari, dan luaran gabungan yang diobservasi adalah 39.7%, 14.0%, 10.6%, dan 21.2% berturut-turut. Kemampuan diskriminasi kecerdasan buatan lebih baik dibandingkan statistik konvensional untuk keempat luaran, dengan AUC lama rawat >5 hari adalah 0.800 vs 0.775, readmisi 0.790 vs 0.732, mortalitas 0.794 vs 0.785, dan luaran gabungan 0.628 vs 0.596.Kesimpulan: Kecerdasan buatan lebih baik dibandingkan statistik konvensional untuk memprediksi luaran klinis berupa lama rawat, readmisi 30 hari, mortalitas 180 hari, dan luaran gabungan pada pasien GJDA dengan penurunan fraksi ejeksi dan DM tipe 2.

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Background: Heart failure patients often experience readmissions with a high mortality rate, therefore early detection and appropriate management are required to improve the prognosis. The risk of hospitalization due to heart failure is increased 1.5x in type 2 diabetes mellitus (DM) patients. Using artificial intelligence, clinical data can be integrated with supporting examinations such as ECG and chest X-ray. Artificial intelligence can also help diagnoses in the cardiovascular field without inter-observer variability, as well as increasing time and cost efficiency.

Objective: This study aims to compare the ability of conventional statistics with artificial intelligence in predicting clinical outcomes, namely length of stay, 30-day readmission, 180- day mortality, and composite outcome in acute decompensated heart failure (ADHF) patients with reduced ejection fraction and type 2 DM.

Methods: A retrospective cohort study was conducted on 292 ADHF patients with reduced ejection fraction and type 2 DM in the period January 2018 – March 2023. Data analysis was carried out using conventional statistics with bivariate and multivariate analysis, where the results were then compared with analysis using artificial intelligence algorithm, namely Balanced Random Forest.

Results: The percentages of outcomes observed for length of stay >5 days, 30 day readmission, 180 day mortality, and composite outcome were 39.7%, 14.0%, 10.6%, and 21.2% respectively. The discrimination ability of artificial intelligence was better than conventional statistics for all four outcomes, with the AUC of length of stay >5 days were 0.800 vs 0.775, readmission 0.790 vs 0.732, mortality 0.794 vs 0.785, and combined outcome 0.628 vs 0.596.

Conclusion: Artificial intelligence is better than conventional statistics in predicting clinical outcomes in the form of length of stay, 30-day readmission, 180-day mortality, and composite outcome in ADHF patients with reduced ejection fraction and type 2 DM."

"ABSTRAKLatar Belakang : Meskipun manajemen gagal jantung (GJ) semakin maju, prognosis pasien tetap belum membaik. Hal ini disebabkan karena adanya komorbid, terutama perburukan fungsi ginjal yang juga memainkan peran utama dalam patofisiologi GJ. Pada tahun 2015, Putri dkktelah mengembangkan sistim skor VKPP untuk memprediksi perburukan fungsi ginjal pada pasien dengan Gagal Jantung Dekompensasi Akut (GJDA), yang variabelnya terdiri atas jenis kelamin perempuan, Hb < 12,5 mg/dl, kreatinin awal > 2,5 mg/dl, riwayat hipertensi, dan usia > 75 tahun. Nilai diskriminasi sistim skor tersebut 0,682 (95% IK; 0,630 - 0,734). Sampai saat ini, belum ada validasi eksternal pada sistim skor VKPP tersebut, sehingga perlu dilakukan agar dapat diimplementasikan secara klinis.Tujuan : Melakukan validasi eksternal sistim skor Kardio-Renal VKPP pada pasien dengan GJDA yang menjalani rawat inap.Metode : Penelitian merupakan studi kohort retrospektif dengan metode validasi eksternal temporal yang dilakukan di Departemen Kardiologi dan Kedokteran Vaskular Universitas Indonesia/Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, menggunakan data sekunder September 2015 hingga April 2016, yang diambil secara consecutive sampling. Analisis data ditujukan untuk mendapatkan nilai kalibrasi dan diskriminasi.Hasil : Sampel akhir berjumlah 418, dengan kejadian perburukan fungsi ginjal sebesar 20,3%. Odds Ratio (OR) semua variabel sesuai dengan OR pada studi VKPP, kecuali variabel jenis kelamin perempuan yang justru tidak menjadi faktor risiko (OR 0,78; 95% IK 0,43-1,45).Setelah dilakukan penghitungan skor VKPP pada semua sampel studi, didapatkan nilai kalibrasi 0,594 dan diskriminasi/AUC sebesar 0,568 (95% IK; 0,502 - 0,634). Pada studi Validasi, kejadian perburukan fungsi ginjal pada kelompok risiko rendah, sedang, dan tinggi yang dihitung menggunakan skor VKPP berurutan sebesar 18,6%, 21,9%, dan 29,6%. Dengan demikian, hanya kelompok risiko rendah yang berada pada rentang probabilitas prediksi perburukan fungsi ginjal yakni 11-26% (pada risiko sedang dan tinggi sebesar 27-49,5% dan 50-80%).Kesimpulan : Sistim skor VKPP secara eksternal valid untuk memprediksi kelompok risiko rendah, namun masih perlu kajian lebih lanjut pada kelompok risiko sedang dan tinggi.

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ABSTRACT

Background : Although the management of Heart Failure (HF) has developed, prognosis of patients still not significantly improved. It is due to comorbidities, especially worsening kidney function, which also plays a major role in the pathophysiology of HF. In 2015, Putri et al have developed a scoring system (VKPP score) to predict worsening of renal function in patients with

Acute Decompensated Heart Failure (ADHF), in which predictors are female, Hb < 12.5 mg/dl, admission creatinine > 2.5 mg/dl, history of hypertension, and age > 75 years . This scoring system yields discrimination value of 0.682 (95% CI; 0.630 to 0.734). Until now, there has been no external validation on the VKPP scoring system, therefore it is needed in order to implement

them clinically.

Objective : To validate externally the VKPP Cardio-Renal scoring system in patients who are hospitalized with ADHF.

Methods : This is a retrospective cohort study with temporal external validation method that performed at the Department of Cardiology and Vascular Medicine, Universitas

Indonesia/National Cardiovascular Center Harapan Kita, using secondary data from September 2015 until April 2016, which taken by consecutive sampling method. The data analysis is intended to develop the value of calibration and discrimination.

Results : The final samples are 418, with 20.3 % incidence of kidney function deterioration. Odds Ratio of all predictors is similar with the result in VKPP study, except female variable which is not a risk factor (OR 0.78; 95% CI; 0,43-1,45). As final, the calibration and

discrimination values are 0.594 and 0.568 (95% CI; 0.502-0.634). In the validation study, the incidence of worsening renal function in the low, moderate, and high risk group which are calculated using VKPP consecutively valued 18.6 % , 21.9 % and 29.6 %. However, only the

low-risk group who were in the range of probability predictions of worsening renal functions, which is 11-26 % (moderate and high risk valued 27 to 49.5 % and 50-80 %)."

"Latar Belakang: Infeksi COVID-19 merupakan penyakit dengan komplikasi multi-organ, salah satunya komplikasi kardiovaskular. Dengan kejadian gagal jantung akut sebagai komplikasi COVID-19 dengan mortalitas dan morbiditas yang tinggi, perlu dilakukan identifikasi faktor-faktor yang berhubungan dengan terjadinya gagal jantung akut pada pasien COVID-19, khususnya pada derajat sedang – berat.Tujuan : Mengetahui prediktor gagal jantung akut pada pasien COVID-19 yang dirawat, khususnya derajat sedang – beratMetode : Metode penelitian bersifat kohort retrospektif. Luaran primer adalah kejadian gagal jantung akut saat perawatan. Terdapat 15 faktor klinis dan laboratoris yang dianalisis secara bivariat dan multivariat.Hasil: Dari total 208 subjek sesuai kriteria inklusi dan eksklusi, sebanyak 73 subjek (35%) mengalami episode gagal jantung akut saat perawatan. Riwayat gagal jantung kronik memiliki risiko 5,39 kali (95% IK: 1,76 – 16,51; p = 0,003) mengalami kejadian gagal jantung akut. Pasien dengan nilai TAPSE < 17 mm memiliki risiko 4,25 kali (95% IK: 1,13 – 16,07; p= 0,033) mengalami gagal jantung akut. Sedangkan pemakaian ACE-i/ARB memiliki risiko 0,16 kali (95% IK: 0,05 – 0,51; p = 0,002) untuk mengalami gagal jantung akut intraperawatan dibandingkan kelompok tanpa pemakaian ACE-i/ARB.Kesimpulan: Riwayat gagal jantung kronik, TAPSE < 17 mm, dan pemakaian ACE-i/ARB diidentifikasi sebagai prediktor kejadian gagal jantung akut pada pasien COVID-19.

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Introduction: COVID-19 infection is a disease with multi-organ complications, including cardiovascular organ. As heart failure is one of COVID – 19 complications that has high morbidity and mortality, we need to identify factors that can predict acute heart failure in COVID – 19, especially in moderate to severe patients.

Objective : to determine predictors of acute heart failure in hospitalized COVID -19 patients

Method : This was a retrospective cohort study. The primary outcome was acute heart failure that happened during hospitalization. There were total of 16 clinical (age, sex, body mass index, hypertension, diabetes, smoking history, coronary artery disease, chronic kidney disease, chronic heart failure, chronic obstructive pulmonary disease, PaO2/FiO2 ratio, non-cardiogenic shock at admission, use of ACE-inhibitors/ARBs during hospitalization, ejection fraction, TAPSE) as well as 6 laboratory parameters (neutrophil - lymphocyte ratio, platelet - lymphocyte ratio, eGFR, D-Dimer, procalcitonin, CRP) that were used in statistical analysis.

Result: From total of 208 subjects with moderate – severe COVID-19, 73 (35%) had acute heart failure. The median time of developing heart failure is 4 ( 1 - 27) days. On multivariate analysis, patients with history of chronic heart failure exhibited a 5.39-fold higher risk of acute heart failure compared with no history of chronic heart failure (95% CI: 1.76 – 16.51; p = 0.003). The risk of acute heart failure was multiplied by 4.25 in patients that was presented with TAPSE <17 mm (95% CI: 1.13 – 16.07; p= 0.033). In contrast, use/continuation of ACE-inhibitors/angiotensin receptor blockers during hospitalization showed reduced risk of acute heart failure (16% of the risk developing acute heart failure compared with patients with no use of ACE-inhibitors/angiotensin receptor blockers). In subjects developing acute heart failure, the mortality rate was 67%, compared with 57% in subjects without acute heart failure (p = 0,028).

Conclusion: History of chronic heart failure, TAPSE <17 mm, and the use of ACE-inhibitors/angiotensin receptor blockers were identified as predictors of acute heart failure in hospitalized COVID-19 patients."

"Self-care merupakan bagian penting dalam upaya peningkatan kualitas hidup pasien gagal jantung. Self-care adalah pengambilan keputusan secara natural oleh individu dalam berperilaku untuk mempertahankan kestabilan fisiologis tubuhnya dan sebagai respon terhadap tanda dan gejala yang terjadi pada diri individu. Keadekuatan individu dalam melakukan self-care dapat dipengaruhi oleh berbagai faktor internal maupun eksternal dari individu. Identifikasi faktor tersebut menjadi bagian penting untuk memberikan asuhan keperawatan mengenai self-care yang efektif. Penelitian ini bertujuan untuk mengidentifikasi pengaruh dari karakteristik responden, status fungsional, komorbiditas, lama diagnosis, tingkat pengetahuan, tingkat depresi, serta dukungan sosial terhadap self-care. Desain penelitian menggunakan cross sectional survey pada 120 responden yang diambil dengan tehnik purposive sampling di Poliklinik Jantung. Penelitian menggunakan kuesioner SCHFI (self-care heart failure index) dalam mengukur self-care responden. Hasil penelitian menunjukan pekerjaan (p=0,055; CI 95%), pendidikan (p=0,232; CI 95%), dan penghasilan (p=0,027; CI 95%) mempengaruhi self-care individu secara signifikan. Responden yang bekerja, berpendidikan tinggi, dan berpenghasilan lebih dari Rp. 2.000.000 memiliki self-care yang lebih adekuat.

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Adherence to self-care is important for heart failure patients to improve their quality of life. Self-care defined as individual naturalistic decision making process that's patients use in the choice of behaviors that maintain physiological stability and as a respons to underlying sign and symptoms. Understanding the factors that enable or inhibit self-care is essential in developing effective health care interventions.

The Aim of study was to analyze and identified factors (characteristic, functional class, comorbidity, time was diagnosed, knowledge, depression, and social support) influencing self-care. Cross sectional design used in this study to measure 120 outpatients using Self-Care Heart Failure Index (SCHFI) Indonesian version questioner.

The result of the study indicated employe/e patients (p=0,055; CI 95%), have education higher than junior high school (p=0,232; CI 95%), and have income higher than Rp. 2.000.000 (p=0,027; CI 95%) showed more adequate in self-care behaviour. Self-care strategies for HF should targeted for patient with lower education, unemployed, and have an income lower than Rp. 2.000.000 to improve their quality of life."

"ABSTRAK Abstrak :Obstructive Sleep Apnea (OSA) erat dikaitkan dengan penyakitmetabolik seperti hipertensi dan dislipidemia. Pasien dengan OSA juga seringditemukan pada pasien gagal jantung.Obsturctive sleep Apnea dapatmemeperberat gagal jantung.Objektif :Penelitian ini bertujuan mengetahuiprevalens dan faktor-faktor yangmemengaruhi kejadian OSA pada pasien gagal jantung kronik di RSUPPersahabatan Jakarta.Metode :Disain penelitian ini adalah potong lintang observasi. Pasien CHF FC I -II berkunjung ke poliklinik jantung dan vaskular RSUP Persahabatan yangmemenuhi kriteria inklusi dan eksklusi. Subjek dilakukan anamnesis,pemeriksaan fisis dan eko kardiografi untuk memastikan diagnosis CHFdandilanjutkan dengan wawancara menggunakan kuesioner Berlin untuk menentukanrisiko tinggi OSA kemudian dilanjutkan pemeriksaan polisomnografi laludilakukan analisis statistik.Hasil :Penelitian potong lintang ini dilakukan pada 70 sampel pasien gagaljantung. Dengan menggunakan kuesioner Berlin diperoleh sebanyak 42 pasien(60%) yang ditemukan berisiko tinggi OSA. Dengan menggunakan uji chi squareditemukan bahwa faktor usia (p=0,988), jenis kelamin (p=0,678), IMT (p=0,170),lingkar leher (p=0,605), lingkar perut (p=0,189), tekanan darah (p=0,922),merokok (p=0,678) dan fraksi ejeksi ≦40% (p= 0.109) tidak ditemukan memilikihubungan bermakna dengan risiko OSA pada pasien gagal jantung. Sementarafaktor ukuran tonsil ditemukan memiliki hubungan bermakna (p=0,005). Dari 42orang tersebut dipilih secara acak 26 orang untuk dilakukan pemeriksaan lanjutanpolisomnografi dan didapatkan pasien gagal jantung menderita OSA ringandengan nilai AHI 5 ? 15 sebanyak 7 pasien (26.7%), OSA sedang dengan AHI15-30 sebanyak 9 pasien (34.5%) dan OSA berat dengan AHI>30 sebanyak 10pasien (38.8%).Kesimpulan :prevalens pasien CHF FC I - II yang memiliki risiko tinggi OSAberdasarkan kuesioner Berlin dengan nilai >2 adalah sebanyak 42 orang (60%)dengan faktor risiko ukuran tonsil yang bermakna menyebabkan terjadinya OSApada CHF ABSTRACT Background: Obstructive Sleep Apnea (OSA) commonly associated withmetabolic disease including hypertension and dyslipidemia. Patients with OSA isalso commonly found in conjunction with heart failure condition.Obstructivesleep apnea can cause CHF getting worstObjective:This study aims to acknowledge prevalence of OSA and influencefactors in heart failure patients in Persahabatan HospitalMethods:Thisobservational cross sectionalstudy was being done in 70 sampleschronic heart failure patients who visited in cardio and vascular disease clinic inPersahabatan Hospital with fuctional class I - II who met the inclusion andexclusion criteria. Subjects were asked for history of disease, physicalexamination and echocardiography then underwentBerlins Questionnaire thenfollowed by polysomnography examination to detect the presence of OSA.Results: Observational cross sectionalstudy done in 70 samples chi square testcan be concluded that age (p=0,988), gender (p=0,678), Body Mass Index(p=0,170), neck circumference(p=0,605), abdominal circumference (p=0,189),blood pressure (p=0,922),smoking (p=0,678) and ejection fraction ≦40%(p=0.109),many factors are not significantly related to the risk of OSA in heartfailure patients.Meanwhile, tonsillar size is found to have significantly related toincidence of OSA in heart failure patients (p=0,005). 46 patients who have highrisk of OSA by Berlins questionnaire selected by random to get 26 patients whowill follow polysomnography examination, result for patients CHF with mildOSA AHI 5 -15 are 7 patients (26.7%), moderate OSA with AHI 15 - 30 are 9patients (34.5%) and severe OSA with AHI ≥ 30 are 10 patients (38.8%).Conclusion:The prevalence of CHF FC I - II with high risk OSA that screenedby Berlins Questionnaire in CHF patiens are 43 patients (60%) with tonsillar sizeis found to have significantly related to incidence of OSA.;Background: Obstructive Sleep Apnea (OSA) commonly associated withmetabolic disease including hypertension and dyslipidemia. Patients with OSA isalso commonly found in conjunction with heart failure condition.Obstructivesleep apnea can cause CHF getting worstObjective:This study aims to acknowledge prevalence of OSA and influencefactors in heart failure patients in Persahabatan HospitalMethods:Thisobservational cross sectionalstudy was being done in 70 sampleschronic heart failure patients who visited in cardio and vascular disease clinic inPersahabatan Hospital with fuctional class I - II who met the inclusion andexclusion criteria. Subjects were asked for history of disease, physicalexamination and echocardiography then underwentBerlins Questionnaire thenfollowed by polysomnography examination to detect the presence of OSA.Results: Observational cross sectionalstudy done in 70 samples chi square testcan be concluded that age (p=0,988), gender (p=0,678), Body Mass Index(p=0,170), neck circumference(p=0,605), abdominal circumference (p=0,189),blood pressure (p=0,922),smoking (p=0,678) and ejection fraction ≦40%(p=0.109),many factors are not significantly related to the risk of OSA in heartfailure patients.Meanwhile, tonsillar size is found to have significantly related toincidence of OSA in heart failure patients (p=0,005). 46 patients who have highrisk of OSA by Berlins questionnaire selected by random to get 26 patients whowill follow polysomnography examination, result for patients CHF with mildOSA AHI 5 -15 are 7 patients (26.7%), moderate OSA with AHI 15 - 30 are 9patients (34.5%) and severe OSA with AHI ≥ 30 are 10 patients (38.8%).Conclusion:The prevalence of CHF FC I - II with high risk OSA that screenedby Berlins Questionnaire in CHF patiens are 43 patients (60%) with tonsillar sizeis found to have significantly related to incidence of OSA.;Background: Obstructive Sleep Apnea (OSA) commonly associated withmetabolic disease including hypertension and dyslipidemia. Patients with OSA isalso commonly found in conjunction with heart failure condition.Obstructivesleep apnea can cause CHF getting worstObjective:This study aims to acknowledge prevalence of OSA and influencefactors in heart failure patients in Persahabatan HospitalMethods:Thisobservational cross sectionalstudy was being done in 70 sampleschronic heart failure patients who visited in cardio and vascular disease clinic inPersahabatan Hospital with fuctional class I - II who met the inclusion andexclusion criteria. Subjects were asked for history of disease, physicalexamination and echocardiography then underwentBerlins Questionnaire thenfollowed by polysomnography examination to detect the presence of OSA.Results: Observational cross sectionalstudy done in 70 samples chi square testcan be concluded that age (p=0,988), gender (p=0,678), Body Mass Index(p=0,170), neck circumference(p=0,605), abdominal circumference (p=0,189),blood pressure (p=0,922),smoking (p=0,678) and ejection fraction ≦40%(p=0.109),many factors are not significantly related to the risk of OSA in heartfailure patients.Meanwhile, tonsillar size is found to have significantly related toincidence of OSA in heart failure patients (p=0,005). 46 patients who have highrisk of OSA by Berlins questionnaire selected by random to get 26 patients whowill follow polysomnography examination, result for patients CHF with mildOSA AHI 5 -15 are 7 patients (26.7%), moderate OSA with AHI 15 - 30 are 9patients (34.5%) and severe OSA with AHI ≥ 30 are 10 patients (38.8%).Conclusion:The prevalence of CHF FC I - II with high risk OSA that screenedby Berlins Questionnaire in CHF patiens are 43 patients (60%) with tonsillar sizeis found to have significantly related to incidence of OSA."