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Abstrak :
Latar Belakang : Rasio netrofil-limfosit (NLR) sudah banyak diteliti memiliki hubungan yang erat dengan luaran penyakit kardiovaskular. Hal ini berhubungan dengan proses inflamasi yang dapat menyebabkan perubahan struktural dan fungsi dari jantung yang dapat dinilai dengan salah satunya fraksi ejeksi (EF). Pasien IMA-EST yang mendapatkan IKPP memiliki resiko untuk mengalami perubahan EF yang berhubungan dengan NLR saat admisi. Tujuan : Mengetahui hubungan antara NLR rendah dengan peningkatan fraksi ejeksi (EF) ventrikel kiri pada pasien IMA-EST yang mendapatkan IKPP. Metode : Desain penelitian ini adalah kohort retrospektif dan data dilaporkan dalam bentuk deskriptif dan analitik korelasi. Dilakukan analisa hubungan NLR admisi pasien STEMI yang mendapatkan IKPP dengan EF ≤50% yang di ambil dengan ekokardiografi selama perawatan, akan kemudian dilakukan ekokardiografi kembali pada bulan ke-3. Hasil : Total sampel penelitian adalah 58 subjek dengan 91,4% merupakan laki-laki. Rerata nilai EF I 42% dan EF ke-2 45,9%. Pasien dibagi menjadi 2 kelompok dengan NLR <7 dan >7. Terdapat perbedaan proporsi antara kedua kelompok yang ditunjukan dengan nilai p sebesar 0,05. Subjek yang mempunyai kadar NLR >7 lebih beresiko sebesar 4,30x untuk tidak mengalami perbaikan. Faktor yang paling dominan yang mempengaruhi perbaikan EF pada penelitian ini adalah NLR <7 dengan OR sebesar 6,56 (1,31-32,84) setelah dikontrol oleh variable lekosit dan multivesel diseases. Kesimpulan : Terdapat hubungan antara NLR dengan perbaikan EF ventrikel kiri pada Pasien IMA-EST yang mendapatkan IKPP ......Background : The neutrophil-lymphocyte ratio (NLR) has been widely studied to have a close relationship with cardiovascular disease outcomes. This is related to the inflammatory process that can cause structural and functional changes of the heart which can be assessed by ejection fraction (EF). STEMI patients who receive Primary PCI are at risk for experiencing changes in EF related to NLR at admission. Objective: To determine the relationship between low NLR and increased left ventricular ejection fraction (EF) in STEMI patients who receive primary PCI. Methods: The design of this study was a retrospective cohort and the data were reported in descriptive and analytic form. An analysis of the relationship between NLR admissions for STEMI patients who received primary PCI with an EF 50% or below were carried out by echocardiography during treatment, then echocardiography was performed again in the 3rd month. Results: The total sample of the study ware 58 subjects with 91.4% of males. The mean score for EF I was 42% and EF 2 was 45.9%. Patients were divided into 2 groups with NLR <7 and >7. There is a difference in the proportion between the two groups as indicated by a p-value of 0.05. Subjects who have NLR levels > 7 are 4,30x more at risk for not experiencing improvement. The most dominant factor influencing the improvement of EF in this study was NLR <7 with an OR of 6.56 (1.31-32.84) after being controlled by leukocyte and multivesel diseases variables. Conclusion: There is a relationship between NLR and left ventricular EF improvement in IMA-EST patients who received PCI

Abstrak :
Agen penghambat beta telah menunjukkan penurunan resiko perawatan atau kematian pasien dengan gagal jantung ringan sampai sedang, tetapi hanya sedikit diketahui mengenai manfaat atau keamanan agen ini pada gagal jantung berat. Dilaporkan satu kasus penggunaan penghambat beta pada gagal jantung berat dengan fraksi ejeksi kurang dari 25%. Laporan manfaat penghambat beta terhadap kesakitan dan kematian pasien dengan gagal jantung ringan sampai sedang juga ditemukan pada pasien dengan gagal jantung berat seperti yang dilaporkan pada kasus ini. (Med J Indones 2002; 11: 174-5)

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Beta-blocking agents have been shown to reduce the risk of hospitalization and death in patients with mild to moderate heart failure, but little is known about the efficacy or safety of these agents in severe heart failure. A case of beta blocker administration in severe heart failure with ejection fraction less than 25% is reported. The reported benefits of beta blockers with regard to morbidity and mortality in patients with mild to moderate heart failure were also found in the patient with severe heart failure as reported in this case. (Med J Indones 2002; 11: 174-5)

Abstrak :
Doksorubisin masih banyak digunakan di Rumah Sakit Kanker Dharmais. Efek samping doksorubisin terhadap jantung yang dapat ditandai dengan adanya penurunan fraksi ejeksi ventrikel kiri perlu mendapatkan perhatian khusus. Penelitian ini bertujuan untuk memperoleh faktor-faktor risiko yang mempengaruhi penurunan fraksi ejeksi ventrikel kiri pada pasien kanker yang mendapatkan kemoterapi doksorubisin di Rumah Sakit Kanker Dharmais. Penelitian dilakukan menggunakan rancangan cross sectional. Data diperoleh dari rekam medis pasien. Populasi adalah pasien kanker yang mendapatkan kemoterapi doksorubisin periode Oktober 2011-Oktober 2013 di Rumah Sakit Kanker Dharmais. Sampel yang memenuhi kriteria inklusi dan ekslusi sebanyak 77 pasien. Faktor-faktor risiko yang dievaluasi adalah jenis kelamin, usia, kombinasi kemoterapi, hipertensi, diabetes mellitus, riwayat penyakit jantung, radiasi pada dada kiri dan penggunaan obat kardiotoksik lain. Penurunan fraksi ejeksi ventrikel kiri setelah kemoterapi doksorubisin terjadi pada 84,5% pasien: penurunan fraksi ejeksi <10% pada 48,1% pasien dan penurunan fraksi ejeksi ventrikel kiri ≥10% pada 36,4% pasien. Hipertensi berpengaruh terhadap penurunan fraksi ejeksi ventrikel kiri ≥10% secara bermakna (p=0,032). Jenis kelamin laki-laki dan radiasi pada dada kiri menunjukkan adanya kecenderungan berhubungan dengan penurunan fraksi ejeksi ventrikel kiri ≥10% (p=0,095 dan p=0,051). Penderita hipertensi yang mendapatkan doksorubisin berpotensi mengalami penurunan fraksi ejeksi ventrikel kiri.

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Doxorubicin was still widely used in Dharmais Cancer Hospitals. The side effect of doxorubicin to the heart which can be characterized by a decline of left ventricular ejection fraction (LVEF) should received special attention. The aim of this study was to determine risk factors associated with the incidence of LVEF decline in cancer patients treated with doxorubicin at Dharmais Cancer Hospital. The study design was cross sectional. Data was collected from patient?s medical record. The populations were cancer patients who got doxorubicin on October 2011-October 2013 at Dharmais Cancer Hospital. The Samples which fulfilled the inclusion and exclusion criteria were 77 patients. Gender, age, chemotherapy combination, hypertension, diabetes mellitus, cardiac diseases history, left chest wall irradiation and the used of other drugs-induced cardiotoxicity were evaluated as risk factors. The amount of patient that declined their LVEF after doxorubicin chemotherapy was 84.5%, consist of 48.1% patients have ejection fraction fall <10%, and 36.4% patients have ejection fraction fall ≥10%. Hypertension significantly related with decline of LVEF ≥10% (p=0.032). Male sex and left chest wall irradiation showed a trend decline of LVEF ≥10% (p=0.095 and p=0.051). Patients with hypertension who got doxorubicin potentially had declined LVEF.

Abstrak :
[ABSTRAK
Latar belakang dan tujuan: Menentukan korelasi nilai Ejection Fraction (EF) ventrikel kiri pada echo 2D dan DSCT jantung pada pasien Penyakit Jantung Koroner (PJK) stabil di RSUPN Cipto Mangunkusumo, sehingga nilai EF ventrikel kiri DSCT jantung dapat dijadikan acuan untuk evaluasi, penatalaksanaan dan prognosis pada PJK stabil yang mempunyai indikasi dilakukan CT jantung. Metode: Analisa retrospektif dari 30 pasien PJK stabil yang menjalani pemeriksaan echo 2D dan DSCT jantung dengan jarak waktu ≤ 3 bulan, meliputi penilaian EF ventrikel kiri. Berdasarkan nomor rekam medis yang ada, dilakukan pengambilan data EF ventrikel kiri echo 2D serta data tambahan lainnya. Nilai EF ventrikel kiri secara DSCT di evaluasi kembali pada cardiac workstation (Siemens, Leonardo), kemudian ditentukan bagaimana korelasinya dengan nilai EF ventrikel kiri secara echo 2D. Analisis statistik penelitian ini menggunakan uji Spearman Hasil: Terdapat perbedaan nilai EF ventrikel kiri sebanyak 4% antara echo 2D dengan DSCT jantung. Perbedaan sebanyak 4% ini tidak bermakna signifikan secara klinis namun bermakna secara statistik. Nilai R Spearman yang didapat adalah 0,17 sementara nilai p 0,364 (p > 0,005), artinya tidak terdapat korelasi antara nilai EF ventrikel kiri secara echo 2D dengan DSCT jantung pada pasien PJK stabil yang menjalani pemeriksaan echo 2D dan DSCT jantung dengan jarak ≤ 3 bulan di RSUPN Cipto Mangunkusumo. Kesimpulan: Walaupun pada penelitian ini secara statistik tidak berkorelasi, namun pada keadaan hasil echo yang borderlineatau pada pasien PJK stabil yang mempunyai indikasi dilakukan CT jantung, nilai EF ventrikel kiri pada CT dapat menjadi acuan untuk penatalaksanaan selanjutnya.

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ABSTRACT
Background and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT. Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test. Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital. Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management.;Background and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT. Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test. Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital. Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management., Background and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT. Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test. Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital. Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management.]

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 :
Latar Belakang: Gagal jantung merupakan salah satu penyebab kematian utama di Indonesia. Jantung dan ginjal berhubungan dengan erat yang dapat dijelaskan oleh sindrom kardiorenal. Saat ini, ada kekurangan data di rumah sakit tersier di Indonesia mengenai hubungan Ejection Fraction (EF) dengan fungsi ginjal. Metode: Penelitian ini merupakan penelitian cross-sectional yang mengikutsertakan pasien gagal jantung di RSUP Dr. Cipto Mangunkusomo tahun 2018 – 2020 sebagai populasi sasaran. Uji Chi-squared digunakan untuk menganalisis korelasi antar variabel. Izin etik diperoleh karena penelitian ini menggunakan manusia sebagai subjeknya. Hasil: Sebanyak 158 subjek diikutsertakan dalam penelitian ini setelah menerapkan kriteria inklusi dan eksklusi. Terdapat 37 (36,6%) pasien HF pada kelompok HFrEF yang memiliki eGFR stadium 3, 4, atau 5. Sedangkan di kelompok HFmrEF atau HFpEF, terdapat 29 (50,9%) dengan eGFR stadium 3, 4 , atau 5 (p-value = 0,115, RR = 0,72). Pasien gagal jantung dengan eGFR stadium 3, 4, atau 5 (n = 8;12,1%) dan eGFR stadium 1 atau 2 (n = 4; 4,3%) termasuk dalam kelompok NYHA kelas III atau IV (p-value = 0,125, RR = 2,79). Kesimpulan: Tidak ada perbedaan proporsi pasien HFrEF dengan HFpEF untuk memiliki eGFR stadium 3, 4, atau 5 serta proporsi pasien HF yang eGFR stadium 3,4 atau 5 dengan eGFR stadium 1 atau 2 untuk dimasukkan pada kelompok NYHA kelas III atau IV. ......Background: Heart failure is considered one of leading cause of death In Indonesia. The heart and kidneys are tightly related which can be explained by the cardiorenal syndrome. There is a paucity of current data in a tertiary hospital in Indonesia regarding the association of Ejection Fraction (EF) with kidney function. Method: This is a cross-sectional study that includes heart failure patients in Dr. Cipto Mangunkusomo Hospital year 2018 – 2020 as the target population. The Chi-squared test is used to analyse the association between the variables. Ethical permission was obtained since this research used humans as the subject. Results: A total of 158 subjects were included in this study after applying the inclusion and exclusion criteria. There were 37 (36,6%) HF patients in the HFrEF group had eGFR stage 3, 4, or 5. Meanwhile, among HFmreEF or HFpEF group, there were 29 (50,9%) with eGFR stage 3, 4, or 5 (p-value = 0,115, RR = 0,72). HF patients in both eGFR stage 3, 4, or 5 (n = 8;12,1%) and eGFR stage 1 or 2 (n = 4; 4,3%) were included in the NYHA class III or IV group (p-value = 0,125, RR = 2,79). Conclusion: There are no differences in the proportion of HFrEF patients with HFpEF to have eGFR stage 3, 4, or 5 as well as in the proportion of HF patients whose eGFR stages 3,4 or 5 with eGFR stages 1 or 2 to be included in the NYHA class III or IV group.

Abstrak :
Latar belakang: Keputusan pasien untuk menjalani bedah pintas koroner dipengaruhi risiko mortalitas. Skor Age, Creatinine and Ejection Fraction ACEF merupakan prediktor mortalitas 30 hari pascabedah pintas koroner yang sederhana dan telah ditunjukkan memiliki performa yang setara dengan skor lain yang lebih kompleks. Tujuan: Menilai performa kalibrasi dan diskriminasi skor ACEF dalam memprediksi mortalitas 30 hari pascabedah pintas koroner di RSUPN Dr. Cipto Mangunkusumo RSCM. Metode: Penelitian ini merupakan studi kohort retrospektif terhadap pasien penyakit jantung koroner dewasa yang menjalani bedah pintas koroner di unit Pelayanan Jantung Terpadu PJT RSCM tahun 2013 ndash; 2015. Usia, kreatinin, dan fraksi ejeksi dinilai sebelum pasien menjalani bedah. Pasien diikuti hingga 30 hari pascabedah untuk dilihat outcome-nya meninggal atau tidak. Performa kalibrasi skor ACEF dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Performa diskriminasi skor ACEF dinilai dengan area under the curve AUC. Hasil: Sebanyak 308 subjek diikutsertakan dalam analisis. Performa kalibrasi skor ACEF dengan uji Hosmer-Lemeshow menunjukkan p=0,991 dan plot kalibrasi menunjukkan koefisien korelasi r=0,95. Performa diskriminasi skor ACEF ditunjukkan dengan nilai AUC sebesar 0,728 IK95 0,644; 0,811. Simpulan: Skor ACEF memiliki performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pascabedah pintas koroner di RSCM. ...... Background: The preference of patients to undergo coronary artery bypass grafting CABG surgery is influenced by the risk of mortality. Age, Creatinine and Ejection Fraction ACEF score is a simple predictor of 30 day mortality following CABG surgery and had been shown to be equivalent to more complex models. Aim: To assess calibration and discrimination performance of ACEF score in predicting 30 day mortality following CABG surgery in Cipto Mangunkusumo Hospital. Methods: This was a retrospective cohort study of adult coronary artery disease patients undergoing CABG surgery in Integrated Cardiovascular Center, Cipto Mangunkusumo Hospital between 2013 ndash 2015. Age, creatinine, and ejection fraction value were obtained before surgery. The subjects were followed up for up to 30 days postoperatively to assess the outcome dead or alive. Calibration performance were assessed by Hosmer Lemeshow test and calibration plot. Discrimination performance were assessed by the area under the curve AUC. Results: A total of 308 subjects were included in analysis. Hosmer Lemeshow test of ACEF score showed p 0.991 and calibration plot showed r 0.95. Discrimination of ACEF score was shown by the AUC value of 0.728 95 CI 0.644 0.811. Conclusion: ACEF score have a good calibration and discrimination performance in predicting 30 day mortality following CABG surgery in Cipto Mangunkusumo Hospital.

Abstrak :
Meskipun kualitas hidup terkait kesehatan telah diteliti secara luas, namun faktor kontekstual pasien cenderung diabaikan. Tujuan dari disertasi ini adalah untuk menguji model kontekstual kualitas hidup terkait kesehatan (health related quality of life-HRQoL) yang diajukan oleh Ashing-Giwa (2005) pada pasien paska infark miokard (IM) dan meneliti peranan prediktor-prediktor yang memengaruhi HRQOL. Variabel yang masuk ke dalam level individual adalah kecemasan, left ventricular ejection fraction (LVEF) dan komorbiditas. Kepuasan pernikahan dan coping religius Islami termasuk dalam level sistemik. Penelitian ini menggunakan desain metode penelitian mixed method explanatory. Pada studi 1, penelitian cross sectional dilakukan terhadap 170 pasien paska IM. Pasien mengisi empat kuesioner (MacNew Health Related Quality of Life, Couple Satisfaction Index, Cardiac anxiety Questionnaire, coping religius Islami). Data LVEF dan komorbiditas pasien didapatkan dari catatan medis. Model teoritis diuji dengan menggunakan structural equation modelling (SEM). Hasil penelitian menujukan bahwa kecemasan memiliki pengaruh langsung yang negatif terhadap HRQOL. Tidak terdapat hubungan yang signifikan antara komorbiditas pasien, coping religius Islami dan LVEF terhadap HRQOL. Kepuasan pernikahan adalah moderator yang signifikan terhadap hubungan antara kecemasan dengan HRQOL. Pada studi 2 dilakukan penelitian kualitatif dengan menggunakan metode multiple case study (studi kasus ganda). Hasil penelitian menujukkan bahwa responden mengalami kecemasan terhadap kecemasan terhadap kematian, kecemasan terhadap bertambah parahnya penyakit dan efek samping pengobatan. IM dihayati sebagai kesempatan kedua untuk menebus kesalahan masa lalu dan adanya dukungan dari pasangan membuat responden lebih mudah untuk menjalani kehidupan paska IM. Aspek lain yang muncul dalam penelitian kualitatif adalah komunikasi antara pasien - dokter dan adanya peran jender terhadap HRQOL responden.

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Although health related quality of life (HRQOL) has been studied extensively, the role of patient’s contextual factors tended to be neglected. The purpose of this dissertation is to test contextual model of health related quality of life proposed by Ashing-Giwa (2005)in post myocardial infarction (MI)  patients and to examine roles of health related quality of life predictors. Variables include in the individual level are anxiety, left ventricular ejection farction and comorbidity. Marital satisfaction and Islamic religious coping are included in the systemic level. An explanatory mixed method study was conducted for this dissertation. For study 1, a cross sectional study included 170 post myocardial infarction (MI) patients was conducted. The patients filled out four questionnaires (MacNew Health Related Quality of Life, Couple Satisfaction Index, Cardiac Anxiety Questionnaire, Islamic Religious Coping. Data regarding patients left ventricular ejection fraction (LVEF) and comorbidity were gathered from patient’s medical status. The theoretical model was tested using structural equation modelling. Structural equation modelling revealed that anxiety had a negative direct relationship to HRQOL. There were no significant relationships among patient’s comorbidity, Islamic religius coping, LVEF and HRQOL Marital satisfaction was a significant moderator of the relationship between anxiety and HRQOL. In study 2, a multiple case study revealed that respondents had anxiety toward death, severity of their disease and medication’s side effects. MI was experienced as a second chance given by God to redeem their misdeed in the past. Supports from spouse made respondents feel at ease to live their daily life after MI. Other aspects emerged in the qualitative study were patients-doctor communication and role of jender in respondents HRQOL.