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"Introduksi: Gagal jantung (GJ) adalah kondisi dimana jantung tidak mampu secara optimal memompa darah untuk konsumsi tubuh. Walaupun dalam tingkat global prevalansi GJ itu tinggi, studi mengenai hubungan status New York Heart Association (NYHA) dan IMT dari pasien GJ masih minim. Sebagai tambahan, tidak seperti di negara lain, studi mengenai profil pasien GJ di Indonesia sudah tua. Oleh karena itu, studi ini bertujuan untuk menyediakan informasi mengenai karakteristik klinik pasien GJ di RSCM dan mengidentifikasi jika adanya korelasi signifikan diantara IMT dan status NYHA pasien GJ.Metode: Ini adalah studi penampang lintang data sekunder yang dilakukan pada tahun 2021. Data dari pasien GJ yang memiliki indikator IMT dan NYHA jelas dari rekam medis PJT dan pusat RSCM dikumpulkan. Semua data berasal dari kunjungan pertama pasien ke RSCM. Data tersebut dianalisa menggunakan SPSS, dimana frekuensi, median, dan interquartile range dari variabel ditelusuri. Hubungan antara IMT dan NYHA diobservasi melalui ANOVA dan regresi logistik. Hasil: 224 data pasien dari RSCM berhasil terkumpulkan. Median usia pasien GJ di RSCM adalah 57 tahun (IQR=13.75). Populasi pria melebihi dibandingkan wanita (66.1%). Pasien obesitas meliputi sepertiga (39.7) dari total populasi. NYHA 2 adalah status NYHA yang paling kerap muncul dalam populasi sample (62.1%). Gejala yang paling sering ditemukan adalah sesak nafas (75.0%), sedangkan sejarah medis yang paling acap adalah gejala jantung iskemik (69.2%). Semua tanda vital dalam jarak normal. Manifestasi klinis yang paling sering muncul adalah ronkhi (36.80%). Pola ECG yang paling sering ditemukan adalah irama sinus normal (61.50%). Kebanyakan pasien memiliki ejeksi fraksi berkurang (58%). Semua indikator lab normal, terkecuali untuk biomarker renal yang tinggi. Terapi farmakologi teradministrasi paling sering adalah B-Blocker dan Antagonis Aldosterone (64.6% dan 66.5%). One way ANOV A menunjukan adanya perbedaan rata rata IMT signifikan (! (2,211) = 7.964, " = <.001, #2 = .06). Konklusi: Profil pasien studi ini sesuai ekspektasi dari kondisi rujukan awal pasien GJ. Profil pasien sample ini dengan studi lain dari Indonesia, akan tetapi menemukan beberapa perbedaan dengan studi dari negara lain. IMT dan NYHA juga ditemukan mempunyai korelasi linear, dengan catatan ada faktor eksternal yang menentukan progresi menuju NYHA 4.

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Introduction: Heart failure is a condition where the heart cannot pump blood for the body. Even though it is high on prevalence globally, the relationship between the presenting New York Heart Association (NYHA) and patients' BMI is still minimally studied. Additionally, HF patients' profile in Indonesia is significantly outdated. This study aims to provide a clinical characteristic of HF patients in RSCM and identify the relationship between BMI and present NYHA status. Methods: This study is a cross sectional secondary data study conducted on 2021. Data of HF patients from PJT and central RSCM medical records with a clear indicator of BMI and NYHA were collected. All data came from the patient's first visit to RSCM. Data were then analyzed using SPSS, where the frequency, median, interquartile range of variables was explored. The relationship between BMI and NYHA was observed using ANOVA and logistic regression. Results: 224 data were collected on this study. The median age of HF patients in RSCM was 57 years old (IQR=13.75). Compared to females, males are more frequent (66.1%). Obese patients comprise one third (39.7%) of the population. NYHA 2 is the most common presenting NYHA, which constitutes half the sample (62.1%). The most common symptom is dyspnea (75.0%), while the most common medical history is previous ischemic heart disease diagnosis (69.2%). All vital signs are within normal range upon inspection. The most common physical manifestation is Ronchi (36.80%). ECG pattern most commonly found is normal sinus rhythm (61.50%). Most patients have reduced ejection fraction (58%). Lab indicators are within the normal range, except for renal biomarkers, which is mainly elevated. Most common medication administered is B- Blocker and Aldosterone Antagonist (64.6% and 66.5%). ANOVA test found significant mean differences between severe NYHA and BMI (! (2,211) = 7.964, " = <.001, #2 = .06) Conclusion: In conclusion, patients from this study are more common to have NYHA 2. Additionally, BMI and NYHA is linear correlated, where other factors apart from BMI may be a significant cause of progression to NYHA 4."

"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."

"Salah satu fokus perhatian dalam tatalaksana gagal jantung adalah manajemen perawatan mandiri (self care) yang dapat memberikan dampak bermakna dalam perbaikan gejala dan tanda gagal jantung, kapasitas fungsional, kualitas hidup, morbiditas dan prognosis. Sejalan dengan hal tersebut penulis tertarik untuk mengembangkan suatu inovasi pemberian edukasi pasien gagal jantung melalui aplikasi mobile yang dapat dibuka melalui smartphone. Dengan metode ini yang penulis sebut aplikasi mobile EduCard, diharapkan pasien dapat lebih sering membaca dan melihat materi edukasi sehingga akan meningkatkan kemampuan untuk melakukan perilaku self care. Pada penelitian ini akan dilihat pengaruh dari edukasi melalui aplikasi mobile EduCarrd terhadap kemampuan melakukan self care pasien gagal jantung. Penelitian ini menggunakan jenis penelitian kuantitatif quasi experiment, pre and post test with control, dimana peneliti akan memberikan intervensi pada subyek penelitian, kemudian membandingkan efek sebelum dan sesudah intervensi terhadap kemampuan melakukan self care pada pasien gagal jantung. Hasil penelitian ini menunjukkan ada peningkatan nilai kemampuan melakukan self care pada kelompok intervensi setelah diberikan intervensi sebesar 3,5 poin. Namun hasil uji statistik tidak bermakna dengan nilai p > 0,05. Sedangkan bila dibandingkan kelompok kontrol maka kemampuan melakukan self care kelompok intervensi berdasarkan hasil uji statistik menunjukkan ada perbedaan yang bermakna dengan nilai p 0,001 pada α 0,05. Kesimpulan bahwa ada pengaruh dari pemberian edukasi melalui aplikasi mobile EduCard terhadap kemampuan melakukan selfcare pasien gagal jantung.

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One of the focuse in the treatment of heart failure is self care management which can provide in improving sign and symptom of heart failure, functional capacity, quality of life, morbidity and prognosis. In line with this, the authors are interested in developing an innovation in providing education for heart failure patient through a mobile application that can be opened through smartphone. With this method that we called it EduCard, it is hoped that patients can read and view educational material more often so that it will increase the ability to perform self care behaviour. In this study the effect of education through mobile application EduCard will be seen on the ability of self care behaviour in heart failure patient. This study uses a quasi experimental quantitative research type pre and post test with control in which the researcher will provide intervention to the research subject and then compare the effects before and after intervention on the ability of self care behaviour in heart failure patients. The results of this study indicate an increasing of the ability to do self care among intervention group post test by 3,5 poin. But the statistical analysis showing not significant with p value > 0,05. When compared to the control group, the ability of self care behaviour in the intervention group by the statistical analysis show a significant difference with p value 0,0001, α 0,05. The conclusion is that there is a significant effect of providing education through mobile application EduCard on the ability of selfcare behaviour of heart failure patients."

"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."

"Intoleransi aktifitas adalah gejala utama yang terjadi pada pasien gagal jantung dan sangat relevan, karena berhubungan dengan kualitas hidup yang buruk dan peningkatan kematian. Kemungkinan etiologi gangguan status fungsional atau intoleransi latihan pada pasien gagal jantung adalah penurunan respon curah jantung terhadap aktivitas fisik, disfungsi otot rangka, dan abnormalitas kapasitas vasodilatasi perifer. Tujuan penelitian : mengetahui efektifitas duke activity status index (DASI) sebagai instrumen dalam pengkajian secara mandiri terhadap kemampuan fisik pada pasien gagal jantung. Metode : studi literatur dari beberapa database elektronik seperti Science Direct, Sagepub dan Proquest dari tahun 2010-2021. Hasil: didapatkan 60 artikel yang terkait dengan hasil pencarian, kemudian dilakukan analisis baik melalui kriteria inklusi dan ekslusi dan didapatkan 5 artikel yang relevan. Kesimpulan: DASI terdiri dari 12 item kuesioner untuk mengkaji status fungsional fisik secara mandiri dan dapat digunakan untuk menilai keterbatasan fisik pasien yang memiliki rentang skor 0-58,2. Hasil pengukuran DASI dibandingkan dengan treadmil, 6MWT (6 minute walk test), MLHFQ (minnesota living with heart failure questionnaire) dan NT-ProBNP dinyatakan signifikan sehingga instrumen ini dinyatakan valid dan reliabel.

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Activity intolerance is a major symptom that occurs in patients with heart failure and is very relevant, because it's associated with a poor quality of life and increased mortality. Possible etiologies of impaired functional status or exercise intolerance in patients with heart failure are decreased cardiac output response to physical activity, skeletal muscle dysfunction, and abnormal peripheral vasodilating capacity.

The purpose: to determine the effectiveness of the duke activity status index (DASI) as an instrument in independent assessment of physical abilities in heart failure patients.

Methods: literature study from several electronic databases such as Science Direct, Sagepub and Proquest from 2010-2021.

Results: obtained 60 articles related to the search results, then analyzed both through inclusion and exclusion criteria and only 5 relevant articles.

Conclusion: The DASI consists of 12 questionnaire items to assess physical functional status independently and can be used to assess the physical limitations of patients who have a score range of 0-58.2. The results of the DASI measurement were compared with the treadmill, 6MWT (6 minute walk test), MLHFQ (Minnesota living with heart failure questionnaire) and NT-ProBNP were declared significant so that this instrument was declared valid and reliable."

"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."

"[ABSTRAKLatar belakang:Hipertensimerupakan salah satu faktor risiko gagal jantung kongestif. Di rawat inap RSUD Pasar Rebo pada tahun 2014, gagal jantung kongestif masuk dalam 10 penyakit terbanyak, dengan biaya total yang cukup besar dan terdapat selisih tarif antara tarif RS dengan tarif JKN, sehingga perlu dilakukan analisis minimalisasi biaya salah satunya pada obat antihipertensi.Tujuan: Penelitian ini bertujuan untuk memilih alternatif yang lebih cost- minimize antara ramipril-spironolakton dengan valsartan pada pengobatan gagal jantung kongestif di RSUD Pasar Rebo tahun 2014.Metode Penelitian: Penelitian ini merupakan penelitian kuantitatifberupa analisis cross-sectional retrospektif. Penelitian dilakukan dengan membandingkan nilai rata-rata biaya total dua alternatif pengobatan gagal jantung kongestif, yaitu ramipril-spironolakton dengan valsartan dengan menggunakan perspektif Rumah Sakit. Komponen biaya langsung medis yang dihitung adalah biaya obat, biaya jasa dokter dan biaya rawat inap. Sedangkan efektivitas dipastikan memiliki efek yang setara.Hasil: Berdasarkan hasil penelitian yang telah dilakukan pada pasien gagal jantung kongestif di RSUD Pasar Rebo tahun 2014 didapatkan bahwa: (1) Nilairata-rata biaya total penggunaan kombinasi obat ramipril-spironolakton sebesar Rp.2.527.743; (2) Rata-rata biaya total penggunaan obat valsartan sebesar Rp.2.430.923; (3) Obat ramipril-spironolakton efektivitasnya tidak berbeda signifikan atau setara dengan obat valsartan; (4) Adanya penghematan pada rata- rata biaya total obat valsartan sebesar Rp.96.820 per pasien; (5) Adanya penghematan pada biaya rawat inap obat valsartan sebesar Rp.299.031 per pasien.Kesimpulan: Obat valsartan memberikan nilai rupiah yang terendah dan menjadi pilihan yang lebih cost-minimize dibandingkan obat ramipril-spironolakton pada pasien gagal jantung kongestif di RSUD Pasar Rebo Tahun 2014.

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ABSTRACTBackground: Hypertension once of risk factor for congestive heart failure. The Pasar Rebo Hospital inpatient care in 2014, congestive heart failure is the top 10 most prevalent diseases, with a large of number total cost and there is a difference between tariff rates RS and JKN rate, so we need a cost-effectiveness analysis one with antihypertensive drug.Objective: This study aimed to choose an alternative that is more cost-minimize between the ramipril-spironolactone with valsartan in the treatment of congestive heart failure at Pasar Rebo Hospital in 2014.Methods: This is a quantitative research in the form of a retrospective cross- sectional analysis. The study was conducted by comparing the average value of total cost of two alternative treatment of congestive heart failure, ramipril- spironolactone with valsartan by using Hospital’s perspective. The direct medical cost component are cost of drugs, cost of physician services and cost of hospitalizations. Whereas effectiveness measuredand firmly to be equivalent.Results: Based on the research that has been conducted in patients with congestive heart failure at Pasar Rebo Hospital in 2014 found that: (1) The average total cost of ramipril-spironolactone’s drugare Rp.2.527.743; (2) The average total cost of valsartan’s drug are Rp.2.430.923; (3) Ramipril- spironolactone’s drug effectiveness does not significantly difference to valsartan’s drug; (4) There is cost saving on the average of total cost using valsartan’s drug Rp.96.820 per patient; (5) There is cost saving on hospitalization cost using valsartan’s drug Rp.299.031 per patient.Conclusions:V alsartan’ s drug give lowest rupiah value and be more cost minimizes option than ramipril-spironolactone’s drug for patient with congestive heart failure at Pasar Rebo Hospital in 2014., Background: Hypertension once of risk factor for congestive heart failure. The Pasar Rebo Hospital inpatient care in 2014, congestive heart failure is the top 10 most prevalent diseases, with a large of number total cost and there is a difference between tariff rates RS and JKN rate, so we need a cost-effectiveness analysis one with antihypertensive drug.Objective: This study aimed to choose an alternative that is more cost-minimize between the ramipril-spironolactone with valsartan in the treatment of congestive heart failure at Pasar Rebo Hospital in 2014.Methods: This is a quantitative research in the form of a retrospective cross- sectional analysis. The study was conducted by comparing the average value of total cost of two alternative treatment of congestive heart failure, ramipril- spironolactone with valsartan by using Hospital’s perspective. The direct medical cost component are cost of drugs, cost of physician services and cost of hospitalizations. Whereas effectiveness measuredand firmly to be equivalent.Results: Based on the research that has been conducted in patients with congestive heart failure at Pasar Rebo Hospital in 2014 found that: (1) The average total cost of ramipril-spironolactone’s drugare Rp.2.527.743; (2) The average total cost of valsartan’s drug are Rp.2.430.923; (3) Ramipril- spironolactone’s drug effectiveness does not significantly difference to valsartan’s drug; (4) There is cost saving on the average of total cost using valsartan’s drug Rp.96.820 per patient; (5) There is cost saving on hospitalization cost using valsartan’s drug Rp.299.031 per patient.Conclusions:V alsartan’ s drug give lowest rupiah value and be more cost minimizes option than ramipril-spironolactone’s drug for patient with congestive heart failure at Pasar Rebo Hospital in 2014.]"

"Gagal jantung merupakan salah satu penyakit kronis yang paling sering memerlukan pengobatan ulang di rumah sakit. Tingginya tingkat readmission pada pasien gagal jantung sering terjadi karena keterlambatan dalam mengenal gejala, ketidakpatuhan terhadap diet dan pengobatan, kurangnya keterampilan dan pengetahuan dalam self care. Self care dapat mencegah terjadinya perburukan sehingga readmission tidak terjadi, selain itu self care juga berdampak terhadap kualitas hidup. Individu dalam melakukan self care dipengaruhi beberapa faktor dari dalam maupun luar individu. Tujuan penelitian ini adalah mengetahui hubungan karakteristik responden, status fungsional, komorbiditas, tingkat depresi, dukungan sosial, persepsi penyakit dengan self care pasien gagal jantung yang readmission. Penelitian menggunakan desain cross sectional dengan tehnik purposive sampling pada 93 responden pasien gagal jantung yang readmission di Ruang Rawat Inap dan Poliklinik Jantung RSUP Persahabatan. Hasil penelitian setelah dianalisis dengan Chi-square menunjukkan status perkawinan (p 0,028; α 0,05), pendidikan (p 0,018; α 0,05), komorbiditas (p 0,034; α 0,05), tingkat depresi(p 0,006; α 0,05), dukungan sosial (p 0,000; α 0,05), dan persepsi penyakit (p 0,002; α 0,05) memengaruhi self care responden secara signifikan. Kesimpulan penelitian ini adalah perlunya meningkatkan follow up setelah pasien pulang dan melibatkan keluarga dalam upaya self care.

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Heart failure is the chronic diseases most often requires repeat treatment at the hospital. The high level of readmission patients heart failure often occurs due to delays in recognizing symptoms, noncompliance diet and treatment, lack of skills and knowledge self care. Self care can prevent deterioration so the readmission does not occur, besides it affects the quality of life. Individuals doing self care influenced by several factors from inside and outside. The purpose of this study to know the relationship of respondent characteristics, functional status, comorbidity, depression, social support, illness perception with self care patients heart failure readmission. The study used design cross sectional with purposive sampling technique in 93 patients heart failure readmission at Inpatient and Outpatient Care RSUP Persahabatan. The results this study after being analyzed by Chi square showed marital status (p 0,028; α 0.05), education (p 0,018; α 0,05), comorbidity (p 0,034; α 0,05), depression (p 0,006; α 0,05), social support (p 0,000; α 0,05), and illness perception (p 0,002; α 0,05) significantly influenced self care. The conclusions this study need to improve follow up after the patient returns home and involves the family effort to self care."

"Self care penderita gagal jantung merupakan penentu keberhasilan perawatan. Self care membutuhkan pengetahuan dan keterampilan yang dapat diberikan melalui discharge planning sejak penderita dirawat. Discharge planning yang tidak maksimal memberikan pengaruh langsung dan menyebabkan rehospitalisasi serta penambahan lama perawatan. Discharge planning membutuhkan kolaborasi multidisiplin, pasien harus terlibat aktif dalam pelaksanaannya. Di Indonesia, rumah sakit mempunyai kewenangan mengatur pelaksanaan discharge planning, namun pada kenyataannya discharge planning disusun hanya dalam bentuk ringkasan yang akan disampaikan seperti jadwal kunjungan dan obat – obatan. Tujuan: mengidentifikasi pengaruh discharge planning terstruktur terhadap self care. Metode: quasy experiment dengan 46 menggunakan 3 kuisioner dan analisis meliputi univariat dan bivariat (beda 2 mean). Hasil: terdapat beda mean yang signifikan sebelum dan sesudah interevensi pada kelompok intervensi. Kesimpulan: terdapat pengaruh pemberian discharge planning terhadap self care. Rekomendasi: dalam perawatan gagal jantung, discharge planning menjadi bagian penting untuk memaksimalkan perawatan dan self care. 

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Self-care of patients with heart failure is a determinant treatment to success. Patient’self-care requires knowledge and skills that can be provided through a program of discharge planning since the patient is admitted to the hospital. The discharge planning program that is not optimally given to the patient will produce direct effect and cause re-hospitalization and possible extended hospital stay. The implementation of the discharge planning requires multidisciplinary collaboration and the patient must be actively involved in the practice. In Indonesia, hospitals have authorities to regulate the implementation of discharge planning program, but in reality, what they said a discharge planning is consists of only a form of medical summary that concluded with a schedule of visits and medicines to be consumed. The objective of the study was to identify the effect of structured discharge planning structured on self-care of patients with heart failure. Method: A quasy experimental study has involved 46 subjects, used 3 different questionnaire and analysis included univariate and bivariate (Two Difference mean). The result showed that there is a significant difference mean before and after intervention in the treatment group. Conclusion: There is a significant effect of structured discharge planning on self-care. Recommendation: A structured discharge planning program becomes an important part of caring for patients with heart failure in order to maximize nursing care and self-care ability of the patients."

"Pendahuluan: Pasien dengan gagal jantung sangat rentan mengalami readmisi yang disebabkan oleh berbagai masalah seperti persepsi terhadap gejala, pengobatan, kepatuhan diet, dukungan sosial, kemampuan kognitif dan ekonomi dalam melaksanakan perawatan diri, persepsi penyakit dan akses ke perawatan kesehatan. Perawatan paliatif kardiovaskular khususnya pada pasien gagal jantung bertujuan agar pasien dan keluarga mendapatkan ketenangan dan merasakan suasana aman baik secara fisik, psikososial, spiritual, dan permasalahan lainnya, serta membuat pasien dan keluarga memiliki pemahaman yang sama dengan perspektif medis. Oleh karena itu penelitian ini bertujuan untuk mengeksplorasi pengalaman keluarga pasien gagal jantung yang mendapatkan perawatan paliatif. Metode: Penelitian menggunakan jenis penelitian kualitatif dengan pendekatan fenomenologi deskriptif. Partisipan dalam penelitian ini yaitu keluarga pasien gagal jantung yang memiliki pengalaman mendapatkan perawatan paliatif, mampu berkomunikasi dengan baik dan jelas, serta bersedia untuk menjadi partisipan dengan memberikan persetujuan melalui informed consent. Hasil: Tema-tema yang teridentifikasi dalam pelelitian ini yaitu: (1) Keluarga mengenali keluhan fisik pasien gagal jantung yang mendapatkan perawatan paliatif, (2) Dukungan keluarga dalam perawatan pasien gagal jantung yang mendapatkan perawatan paliatif, (3) Alasan mendapatkan perawatan paliatif, (4) Persepsi keluarga terhadap perawatan paliatif. Kesimpulan: Keluarga memainkan peran penting dalam perawatan pasien gagal jantung yang mendapatkan perawatan paliatif dalam mendampingi pasien selama perawatan di rumah sakit hingga perawatan selanjutnya ketika pulang kerumah. Dengan adanya dukungan dari tim perawatan paliatif dalam bentuk pendampingan bagi pasien dan keluarga, mampu memberikan dampak positif serta meningkatkan kualitas hidup. Sehingga dibutuhkan tim perawatan paliatif khususnya perawat kardiovaskular yang professional yang dapat memenuhi kebutuhan pasien gagal jantung beserta keluarga dalam memberikan layanan perawatan paliatif yang berkualitas di Indonesia.

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Introduction: Patients with heart failure are very susceptible to readmission caused by various problems such as perception of symptoms, medication, dietary compliance, social support, cognitive and economic abilities in carrying out self-care, perception of illness and access to health care. Cardio palliative care, especially for patients with heart failure, aims to make patients and families feel calm and feel a safe atmosphere both physically, psychosocially, spiritually, and other problems, as well as to make patients and families have the same understanding from a medical perspective. Therefore, this study aims to explore the experiences of families of heart failure patients receiving palliative care.

Method: This research uses a qualitative research type with a descriptive phenomenological approach. Participants in this study were families of heart failure patients who had experience in receiving palliative care, were able to communicate well and clearly, and were willing to become participants by giving informed consent.

Results: The themes identified in this research were: (1) Families recognize the physical complaints of heart failure patients who receive palliative care, (2) Family support in caring for heart failure patients receiving palliative care, (3) Reasons for receiving palliative care, (4) Family perceptions of palliative care. Conclusion: The family plays an important role in the care of heart failure patients who receive palliative care in accompanying patients during treatment at the hospital until further care when they return home. With the support of the palliative care team in the form of assistance for patients and families, it can have a positive impact and improve the quality of life. So that a palliative care team is needed, especially professional cardiovascular nurses who can meet the needs of heart failure patients and their families in providing quality palliative care services in Indonesia."