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Abstrak :
Latar belakang: Program Rujuk Balik merupakan program pelayanan kesehatan yang diberikan kepada peserta dengan penyakit kronis yang sudah stabil namun masih membutuhkan pengobatan jangka panjang. Evaluasi BPJS Kesehatan tahun 2018 menunjukkan bahwa RSU Hasanah Graha Afiah (HGA) memiliki 3511 pasien potensial PRB yang harus dikembalikan ke FKTP namun sampai dengan tahun 2020 RSU Hasanah Graha Afiah masih belum berhasil memenuhi target tersebut. Berdasarkan data 10 diagnosa terbanyak kunjungan instalasi rawat jalan RSU HGA tahun 2020, Chronic Heart Failure (CHF) menduduki peringkat no 1 dengan jumlah kunjungan 9667 kunjungan dan hanya 35 pasien CHF yang mengikuti PRB. Hasil kredensial RSU HGA tahun 2020 menunjukkan bahwa skor pencapaian PRB 100 % hanya 4.6 % sehingga terancam untuk tidak dapat melanjutkan kerja sama. Metode: Penelitian ini merupakan penelitian kuantitatif kasus kontrol dan kualitatif. Instrumen yang digunakan adalah kuisioner, formulir data klinis dan pedoman wawancara. Analisis dilakukan dengan melihat karakteristik, data klinis, pengetahuan, tingkat kepatuhan minum obat masing-masing kelompok dan mengetahui faktor-faktor yang mempengaruhi kinerja PRB serta pandangan informan tentang PRB. Hasil dan Kesimpulan: Pengetahuan tinggi memiliki OR sebesar 31.0 kali lebih besar (95% interval kepercayaan 7.0 – 136.9) untuk melakukan PRB dibandingkan dengan skor pengetahuan rendah setelah dikontrol oleh variabel lain. Hasil analisis kualitatif menunjukkan bahwa masih ada peserta BPJS Kesehatan yang belum paham mengenai PRB, tidak tersedianya obat-obatan di apotik rekanan, pelayanan di FKTP yang belum optimal dan tingkat kepercayaan peserta BPJS Kesehatan yang rendah terhadap FKTP menyebabkan PRB tidak berjalan dengan baik. Saran: Sosialisasi alur dan manfaat PRB bagi peserta BPJS Kesehatan, peningkatan pengetahuan DPJP mengenai kriteria stabil, peningkatan kualitas pelayanan di FKTP dan peningkatan kualitas pelayanan farmasi di apotik rekanan terutama ketersediaan obat-obatan bagi peserta PRB diharapkan dapat mengoptimalkan PRB. ......Background: Referral Program (PRB) is a health service program that is provided to participants with chronic diseases who are stable but still require long-term treatment. The 2018 Health BPJS evaluation showed that RSU Hasanah Graha Afiah (HGA) had 3511 PRB potential patients who had to be returned to the FKTP but until 2020 RSU HGA had not yet succeeded in meeting this target. Based on data from the 10 diagnoses with the most outpatient visits at RSU HGA in 2020, Chronic Heart Failure (CHF) was ranked number 1 with 9667 visits and only 35 CHF patients took PRB. The results of the 2020 RSU HGA credential showed that the 100% PRB achievement score is only 4.6% so it is threatened not to be able to continue cooperation. Methods: This study is a quantitative case-control and qualitative study using a questionnaire instrument, clinical data form and interview. The analysis was conducted by looking at the characteristics, clinical data, knowledge and level of adherence to taking medication for each group and knowing the factors that affect the performance of PRB as well as informant outlook of PRB. Results and Conclusions: High knowledge has an OR of 31.0 times greater (95% confidence interval 7.0 – 136.9) for doing PRB compared to low knowledge scores after being controlled by other variables. The results of the qualitative analysis show that there are still BPJS Kesehatan participants who do not understand about PRB, the unavailability of medicines at partner pharmacies, FKTP services that are not optimal and the low level of trust of BPJS Kesehatan participants in FKTP causes PRB not to work well. Suggestion: Socialization flow and benefit of PRB for BPJS Kesehatan participants, DPJP knowledge improvement in stable criteria, improving service quality in FKTP and partner pharmacies especially in medicine availability hopefully will enhance PRB quality.

Abstrak :
Latar belakang : Pasien gagal jantung kronik memerlukan evaluasi pemeriksaan ekokardiografi. Berbagai metode pemeriksaan digunakan dalam pemeriksaan ekokardiografi, diantaranya pemeriksaan LAEF, LAVI, dan LVEF yang terkait dengan penelitian ini. Metode pemeriksaan LAEF dan LAVI memiliki peran dalam menilai remodelling atrium kiri, sedang LVEF terkait dengan fungsi sistolik ventrikel kiri. Tujuan : Penelitian ini bertujuan menilai korelasi nilai LAEF dan LAVI dengan nilai LVEF pada < 40% dan ≥ 40%. Metode : Studi potong lintang pada 150 pasien gagal jantung kronik yang dilakukan pemeriksaan ekokardiografi trans-torakal di eko-lab PJT RSCM.Pemeriksaan ekokardiografi metode LAEF dengan metode area length (2 dimensi) pada minimal 2 view eko, sedangkan LAVI dengan metode 2 dimensi. Pemeriksaan LVEF dengan metode Simpson. Hasil : Pada penelitian didapatkan 150 subjek dengan nilai median LAVI 30,9mL/m2 (RIK 22,08-40,80), nilai median LVEF 55,75 % (RIK 40,75-61,85), nilai LAEF median 31,8 % (RIK 23,98-38,30). Korelasi nilai LAEF dengan nilai LVEF pada LVEF < 40% dengan hasil korelasi positif sedang bermakna (r = 0,614; p <0,001), pada LVEF ≥ 40% dengan hasil korelasi positif sedang bermakna (r =0,580 ; p < 0,001). Korelasi nilai LAVI dengan nilai LVEF pada LVEF < 40% dengan hasil berkorelasi negatif lemah dan tidak bermakna (r = -0,093; p = 0,722), sedangkan pada LVEF ≥ 40% dengan hasil berkorelasi negatif lemah bermakna (r = -0,299; p < 0,001). Dilakukan sub-analisis pada LVEF 40-50%, didapatkan nilai LAEF dan nilai LVEF berkorelasi positif lemah bermakna (r = 0,492; p <0,001). Lalu sub-analisis pada LVEF ≥ 50%, didapatkan korelasi nilai LAEF dan nilai LVEF positif lemah tidak bermakna (r = 0,205; p = 0,063). Kesimpulan : Terdapat korelasi positif nilai LAEF dengan nilai LVEF pada pasien gagal jantung kronik baik pada HFrEF (LVEF < 40%) dan LVEF ≥ 40%, sehingga nilai LAEF pada cut-off nilai LVEF 40% dapat menjadi salah satu marker menilai proses remodelling atrium kiri. Sedangkan nilai LAVI dengan LVEF pada pasien gagal jantung kronik ditemukan korelasi lemah atau tidak adanya korelasi. ......Background : Patients with chronic heart failure require echocardiographic evaluation. Various examination methods were used in echocardiographic examinations, including LAEF, LAVI, and LVEF examinations related to this study. LAEF and LAVI examination methods have a role in assessing left atrial remodeling, while LVEF is related to left ventricular systolic function. Objective : This study aims to assess the correlation between LAEF and LAVI values with LVEF values at LVEF < 40% and LVEF 40%. Methods : A cross-sectional study of 150 patients with chronic heart failure who underwent transthoracic echocardiography at the RSCM PJT eco-lab. Echocardiographic examination using the LAEF method with the area length method (2 dimensions), in at least 2 eco views, while the LAVI using the 2-dimensional method. LVEF examination by the Simpson method. Results : The study found 150 subjects with a median LAVI value of 30.9 mL/m2 (IQR 22.08-40.80), a median LVEF value of 55.75% (IQR 40.75-61.85), a median LAEF value of 31 ,8% (IQR 23.98-38.30). The correlation between the LAEF value and the LVEF value at LVEF < 40% has a moderately significant positive correlation (r = 0.614; p < 0.001), while at LVEF ≥ 40% has a moderately significant positive correlation (r = 0.580 ; p < 0.001). The correlation between the LAVI value and the LVEF value at LVEF < 40% has a weak and insignificant negative correlation (r = -0.093; p = 0.722), while at LVEF ≥ 40% has a weak negative significant correlation (r = -0.299; p < 0.001). Sub-analysis was performed on LVEF 40-50%, and the LAEF value and LVEF value were positively and significantly correlated (r = 0.492; p < 0.001). Then the sub-analysis at LVEF > 50%, it was found that the correlation between the LAEF value and LVEF value were weak positive and not significant correlated (r = 0.205; p = 0.063). Conclusion : There is a positive correlation between LAEF values and LVEF values in chronic heart failure patients both at HFrEF (LVEF < 40%) and LVEF ≥ 40%, so that the LAEF value at the cut-off LVEF 40% can be one of the markers to assess the left atrial remodeling process. While the value of LAVI with LVEF in patients with chronic heart failure found a weak correlation or no correlation.

Abstrak :
Gagal jantung adalah sindrom progresif yang menyebabkan kualitas hidup yang buruk bagi pasien. Insidensi dan prevalensi gagal jantung terus meningkat. Saat ini, banyak bukti menunjukkan bahwa gagal jantung kronis dikarakteristikkan oleh aktivitas kompensasi neurohormonal yang berlebihan, termasuk overaktivitas simpatis yang kemudian menjadi landasan terapi. Diperlukan penatalaksanaan yang holistik dan komprehensif meliputi modifikasi gaya hidup, diet, serta intervensi farmakologi. Beberapa penelitian klinis menunjukkan bahwa akupunktur memiliki efek terapeutik dan modulatoris pada kondisi yang menjadi faktor risiko gagal jantung. Salah satu modalitas akupunktur adalah elektroakupunktur yang dapat menurunkan aktivitas simpatis dan menghambat respon reflek simpatoeksistoris kardiovaskuler. Penelitian ini merupakan uji klinis double blind randomized controlled trial (RCT), yang melibatkan 42 orang pasien gagal jantung dengan kriteria NYHA II-III, EF <40% terbagi dalam kelompok medikamentosa dan elektroakupunktur, medikamentosa dan elektroakupunktur sham, dan medikamentosa tanpa elektroakupunktur. Terapi dilakukan sebanyak 16 sesi selama 8 minggu. Pengukuran dilakukan pada awal terapi, pertengahan terapi, dan akhir terapi. Hasil menunjukkan pemberian elektroakupunktur pada terapi utama medikamentosa pada pasien gagal jantung mampu meningkatkan fraksi ejeksi, mean arterial pressure, dan menurunkan LVEDP lebih cepat, mempertahankan stabilitas dari heart rate variability, serta meningkatkan kualitas hidup yang diukur menggunakan uji jalan 6 menit secara signifikan. ......Heart failure is a progressive syndrome that causes poor quality of life for patients. The incidence and prevalence of heart failure continues to increase. At present, much evidence shows that chronic heart failure is characterized by excessive neurohormonal compensatory activity, including sympathetic overactivity which later became the basis of therapy. Holistic and comprehensive management is needed including lifestyle modification, diet, and pharmacological interventions. Some clinical studies show that acupuncture has a therapeutic and modulator effect on conditions that are risk factors for heart failure. This study is a double blind clinical trial randomized controlled trial (RCT), involving 42 people with heart failure patients with NYHA II-III criteria, EF <40% divided into medical and electroacupuncture, medical and electroacupuncture sham, and medical without electroacupuncture groups. Therapy was done 16 sessions for 8 weeks. Measurements of the variables were carried out at the beginning of therapy, mid-therapy, and end of therapy. The results of showed that electroacupuncture in the top of guidlines medical therapy in heart failure patients were able to increase ejection fraction, mean arterial pressure, and to decrease LVEDP faster, maintain stability of heart rate variability, and improve quality of life measured using the 6 minute road test significantly.

Abstrak :
Penelitian ini bertujuan membuktikan korelasi antara mobilitas dan kualitas hidup pada pasien gagal jantung kronik stabil. Penelitian potong lintang ini dilakukan menggunakan instrumen Timed Up and Go Test dan SF 36 pada 50 subyek gagal jantung kronik yang menjalani rawat jalan. Hasil penelitian ini adalah nilai korelasi antara waktu tempuh Timed Up and Go Test dan nilai total SF 36 serta subskalanya. Penelitian ini mendapatkan rerata waktu tempuh Timed Up and Go Test adalah 10,68 detik dan rerata nilai total SF 36 66 (+16,49). Pada masing masing subskala SF 36 didapatkan nilai tengah pada skala fungsi fisik adalah 77,5 (15-100), skala nyeri 67,5 (22-100), skala kesehatan umum 70 (40-90), skala kesehatan jiwa 84 (40-96), skala peranan fisik 0 (0-100), skala peranan emosional 100 (0-100), skala energi 67,5 (20-90), dan skala fungsi sosial 87,5 (37,5-100). Pada skor total terdapat korelasi negatif rendah ( r = -0.280 ) dengan tingkat mobilitas. Pada skala SF 36, mobilitas memiliki korelasi negatif dengan skala fungsi fisik ( r = -0.464 ) dan energi ( r = -339 ). Temuan ini menunjukkan bahwa semakin singkat waktu tempuh TUGT, semakin baik kualitas hidup, terutama fungsi fisik dan energi pada subyek. Pada skala lain, tidak didapatkan korelasi bermakna. ......This study aims to prove a correlation between mobility and quality of life in patients with stable chronic heart failure. This cross-sectional study was conducted using the Timed Up and Go Test and SF 36 instruments on 50 subjects with chronic heart failure. The results of this study were correlation values ​​between the travel time of Timed Up and Go Test and the total value of SF 36 and their subscale. This study found that the average travel time of the Timed Up and Go Test was 10.68 seconds and the mean total value of SF 36 is 66 (+16.49). In each SF 36 subscale, the median score on the scale of physical function was 77.5 (15-100), pain scale 67.5 (22-100), general health scale 70 (40-90), mental health scale 84 (40 -96), physical role scale 0 (0-100), emotional role scale 100 (0-100), energy scale 67.5 (20-90), and social function scale 87.5 (37,5-100). In the total score there is a low negative correlation (r = -0.280) with the level of mobility. Mobility has a moderate negative correlation with physical function scale (r = -0.464) and energy (r = -339). This finding shows that the shorter the TUGT travel time, the better the quality of life, especially physical and energy functions in the subject. On other scales, no significant correlation was found.

Abstrak :
ABSTRAK
Tujuan: mendapatkan kuesioner Minnesota Living with Heart Failure MLHFQ versi bahasa Indonesia yang sahih dan handal untuk digunakan di Indonesia. Metode: studi ini merupakan studi potong lintang dengan 85 subyek rerata usia 58 11, pria 55 pasien gagal jantung kronik di poli kardiologi Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Jakarta. Kesahihan diuji dengan menilai kesahihan konstuksi multitrait multimethod analysis dan kesahian eksternal dengan membandingkan dengan kuesioner SF-36. Keandalan dinilai dengan menggunakan cronbach ?, dan intraclass coefficient correlation ICC . Hasil: MLHFQ bahasa Indonesia memiliki korelasi sedang-kuat antara domain dan item pertanyaan r 0,571-0,748, ABSTRACT
Aim to obtain a valid and reliable Indonesian version of MLHFQ for Indonesian application. Methods This cross sectional study enroled 85 patients mean age 58 11, male 55 with chronic heart failure of of cardiology clinic Ciptomangunkusumo Central Hospital Jakarta. Validity of MLHFQ was evaluated by measuring construct validity using multitrait multimethod analysis and by compairing MLHFQ with SF 36. Reliability of MLHFQ was evaluated by calculating Intraclass Correlation Coefficient ICC and by calculating cronbach to determine internal consistency Results Indonesian version of MLHFQ has moderated strong correlation item to domain correlation r 0,571 0,748, p

Abstrak :
Objektif: Penelitian ini bertujuan untuk mengetahui karakteristik subjek penelitian dan pengaruh latihan aerobik selama delapan minggu terhadap perbaikan kualitas hidup menggunakan kuesioner Minnesota Living with Heart Failure (MLHF). Metode: Penelitian ini adalah studi pre dan post latihan aerobik pada pasien gagal jantung kronik stabil. Subjek penelitian melakukan latihan berjalan tiga kali seminggu dengan intensitas sesuai Rating of Perceived Exertion 12-13, durasi latihan dimulai selama 10 menit dengan penambahan jarak 100-200 meter per sesi latihan berdasarkan toleransi subjek selama delapan minggu dan penilaian kualitas hidup menggunakan kuesioner Minnesota Living with Heart Failure dan uji jalan enam menit sebelum dan sesudah latihan aerobik selama delapan minggu. Hasil: Jumlah subjek penelitian sebesar 20 subjek (15 laki-laki dan 5 perempuan). Subjek penelitian didominasi oleh lanjut usia (10 orang), sudah menikah (16 orang), riwayat pendidikan DIII/S1 (10 orang), status bekerja (11 orang), obesitas tingkat I (7 orang), kelas fungsional NYHA II (19 orang), kondisi penyerta berupa hipertensi (16 orang) dan gaya hidup sedenter (18 orang). Perbandingan skor kuesioner MLHF sebelum dan sesudah latihan aerobik mengalami perbaikan bermakna secara statistik (p < 0.001), dimana skor domain fisik dan domain emosional mengalami perbaikan yang bermakna secara statistik (p < 0,001). Perbandingan delta domain fisik dengan delta domain emosional didapatkan bermakna secara statistik (p < 0,001). Perbandingan uji jalan enam menit sebelum dan sesudah latihan aerobik bermakna secara statistik (p< 0,001). Didapatkan hubungan bermakna secara statistik antara usia (p= 0,009) dan status pernikahan (p= 0,037) terhadap skor MLHF. Kesimpulan: Terdapat perbaikan kualitas hidup pada gagal jantung kronik stabil setelah latihan aerobik fase II selama delapan minggu. Terdapat hubungan pada usia dan status pernikahan terhadap skor MLHF. ......Objective: This study aims to determine the characteristics of study subjects and the impact of aerobic exercise over eight weeks on the improvement of quality of life using the Minnesota Living with Heart Failure (MLHF) questionnaire. Method: This is a pre and post-aerobic exercise study on stable chronic heart failure patients. Study subjects engaged in walking exercises three times a week with an intensity based on the Rating of Perceived Exertion of 12-13. Exercise duration started at 10 minutes with an addition of 100-200 meters per exercise session based on the subject's tolerance over eight weeks. Assessment of quality of life was conducted using the Minnesota Living with Heart Failure questionnaire and six-minute walking test before and after aerobic exercise for eight weeks. Result: The total number of study subjects was 20 (15 males and 5 females). Study subjects were predominantly elderly (10 individuals), married (16 individuals), with a Diploma/Bachelor education background (10 individuals), employed (11 individuals), categorized as class I obesity (7 individuals), NYHA functional class II (19 individuals), having hypertension comorbidity (16 individuals), and leading a sedentary lifestyle (18 individuals). Comparison of MLHF questionnaire scores before and after aerobic exercise showed a statistically significant improvement (p < 0.001), with significant improvements in both physical and emotional domains (p < 0.001). Comparison of the delta in the physical domain and the emotional domain was also statistically significant (p < 0.001). Comparison of the six-minute walking test before and after aerobic exercise was statistically significant (p < 0.001). There was a statistically significant association between age (p= 0.009) and marital status (p= 0.037) with MLHF scores. Conclusion: There was an improvement of quality of life in stable chronic heart failure patients after aerobic exercise in phase II for eight weeks. There was a significant association between age and marital status with MLHF scores.

Abstrak :
Background: Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most commonly used questionnaire and it has a good EMPRO (Evaluating the Measurement of Patient-Reported Outcomes) score. The MLHFQ has been adapted and used by various countries worldwide. However, to be utilized in Indonesia, it needs validity and reliability studies. This study aimed to obtain a valid and reliable Indonesian version of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) so that it can be used in Indonesia. Methods: the present study was a cross sectional study with 85 subjects (mean age 58 (SD 11) years; 55% subjects were male) who had chronic heart failure and was treated at the outpatient clinic of cardiology in Dr. Cipto Mangunkusumo Hospital, Jakarta. Validity of the MLHFQ was assessed by evaluating the construct validity using multitrait-multimethod analysis and external validity was evaluated by compairing the MLHFQ with the SF-36 questionnaire. Reliability was assessed using Cronbachs and intraclass correlation coefficients (ICC). Results: the Indonesian version of the MLHFQ had moderate-to-strong correlation between domains and items in questionnaire (r: 0.571-0.748; p<0.01) and it had moderate negative correlation with SF-36 questionnaire (r -0.595; p<0.001). The Cronbach α of Indonesian version of MLHFQ was 0.887; while the ICCs was 0.918. Conclusion: the Indonesian version of MLHFQ has good validity and reliability to asses the quality of life of patients with chronic heart failure in Indonesia.