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Abstrak :
[ABSTRAK
Latar 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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ABSTRACT
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., 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.]

Abstrak :
Penelitian cross sectional dengan sampel 96 responden di RSUP Dr. Sardjito Yogyakarta, RSUD Kota yogyakarta dan RSUD Sleman. Tujuannya adalah untuk mengetahui faktor-faktor yang berhubungan dengan kejadian rawat inap ulang di rumah sakit pada pasied dengan CHF. Analisis chi-square dan multiple logistic regression. Hasil menunjukkan, ada hubungan yang signifikan antara faktor kepatuhan terhadap terapi, riwayat hipertensi, usia, kepatuhan terhadap diet, kepatuhan terhadap cairan dan tingkat kecemasan dengan kejadian rawat inap ulang di rumah sakit pada pasien dengan gagal jantung kongestif. Faktor yang paling dominan adalah riwayat hipertensi.

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The cross sectional study on 96 samples. Its target to know factors related to readmission on patient with CHF, was taken from RSUP Dr. Sardjito Yogyakarta, RSUD Yogyakarta and RSUD Sleman. The objectives in to know factors related to readmission patient with CHF. Multiple Logistic Regression analysis abd chi square, at CI 95%. Result: there is a significant relation between compliance factor to therapy, hypertensionhistory, age, compliance to diet, compilance diution, and anxiety level with readmission CHF patient. The most dominant factor is hypertension history.

Abstrak :
Gagal jantung merupakan salah satu jenis penyakit jantung dengan insiden, prevalen serta mortalitas yang terus meningkat. Penelitian ini bertujuan untuk mengetahui pengaruh keteraturan berobat terhadap kesintasan lima tahun penderita gagal jantung kongestif (GJK). Desain penelitian adalah kohort retrospektif. Sampel sebanyak 402 orang penderita baru GJK yang didiagnosis antara tahun 2001 s.d. 2002 dan dirawat di Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita. Ditemukan penderita GJK yang meninggal selama lima tahun follow up adalah 78 orang (19,4%). Probabilitas kesintasan penderita GJK adalah sebesar 88,65% (tahun pertama), 80,11%(tahun ke dua). 72.22% (tahun ke tiga), 63,75% (tahun ke empat) dan 54,41% (tahun ke lima). Penderita GJK yang tidak teratur berobat mempunyai risiko kematian lebih tinggi dari pada yang berobat teratur. Pada analisis Cox regression keteraturan berobat merupakan yariabel independen pada kesintasan penderita GJK (HR:1,95; 95% Cl: 1.23-3.11). Faktor-faktor Iain yang juga bermakna terhadap kesintasan penderita GJK adalah Ejection Fraction (HR:1,91; 95% Cl:1,18-3,08), Diabetes Melitus (HR:1,85; 95% Cl:1,08-3,18). Beberapa variabel pada penelitian ini hubungannya tidak bermakna terhadap kesintasan penderita GJK yaitu: umur, rokok,functional, riwayat PJK , hipertensi , kreatinin dan tindakan pengobatan. Keteraturan berobat terbukti mempengaruhi probabilitas kesintasan penderita GJK. Penderita GJK disarankan untuk senantiasa melakukan pemeriksaan dan pengobatan secara teratur. ......Heart failure is one of cardiovascular disease which incidence, prevalence and mortality remain height and increased. The purpose of this study was to evaluate the effect of routine medical evaluation (compliance) on five year survival rate of patients hospitalized due to congestive heart failure. The Study design used in this study is retrospective cohort with 402 patients of newly diagnosis congestive heart failure (CHF) admitted in year 2000 to 2001 at National Cardiovascular Center - Harapan Kita, Jakarta. During 5 year follow-up, 78 patients died. Survival at 1 to 5 years was in order of 88,65%, 80,11%, 72,22%, 63,75%, and 54,41%, respectively. CHF patients who did not underwent routine medical evaluation had higher prognostic of death than CHF patients who had medical evaluation routinely. By Cox regression analyses, the independent predictors of mortality were routine evaluation (HR:1,95; 95% CI: 1.23-3.11). low ejection fraction (HR:1,91; 95% CI:1,18-3,08), and diabetes mellitus (HR:1,85; 95%CI:1,08-3,18). Other predictors were not statistically significant, i.e: age, gender, smoking, functional class, coronary heart disease, creatinine, and the medication. The status of compliance is an independent predictor of survival for patients with CHF, besides low ejection tiaction and diabetes mellitus. These evaluation, like the other research, suggested the importance of compliance in the treatment of CHF.

Abstrak :
Latarbelakang: Gagal jantung merupakan salah satu jenis penyakit jantung dengan insiden, prevalen serta mortalitas yang tenis meningkat. Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh keteraturan berobat terhadap kesintasan lima tahun penderita gagal jantung kongestif (GJK). Desain: Desain penelitian adalah kohort retrospektif. Sampel sebanyak 402 orang penderita baru GJK yang didiagnosis antara tahun 2001 s.d. 2002 dan dirawat di Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita. Hasil dan Diskusi: Ditemukan penderita GJK yang meninggal selama lima tahun follow up adalah 78 orang (19,4%). Probabilitas kesintasan penderita GJK adalah sebesar 88,65% (tahun pertama), 80,11%(tahun ke dua), 72,22% (tahun Ice tiga), 63,75% (tahun ke empat) dan 54,41% (tahun ke lima). Penderita GJK yang tidal( teratur berobat mempunyai risiko kematian lebih tinggi dari pada yang berobat teratur. Pada analisis Cox regression keteraturan berobat merupakan variabel independen pada kesintasan penderita GJK (HR: 1,95; 95% CI: 1.23-3.1 I). Faktor-faktor lain yang juga bermakna terhadap kesintasan penderita GJK adalah Ejection Fraction (HR:1,91; 95% CI:1,1 8-3,08), Diabetes Melitus (HR:1,85; 95%C1:1,08-3,18). Beberapa variabel pada penelitian ini hubungannya tidak bermakna terhadap kesintasan penderita GJK yaitu: umur, rokok,functional, riwayat PJK, hipertensi , kreatinin dan tindakan pengobatan. Kesimpulan dan saran: Keteraturan berobat terbukti mempengaruhi probabilitas kesintasan penderita GJK. Penderita GM( disarankan untuk senantiasa meiakukan pemeriksaan dan pengobatan secara teratur. ......The effect of compliance on five year survival rate of congestive heart failure patients at National Cardiovascular Center Harapan Kita. xviii + 99 pages, 8 tables, 6 figures, 9 appendices. ABSTRACT Background. Heart failure is one of cardiovascular disease which incidence, prevalence and mortality remain height and increased. Aims. The purpose of this study was to evaluate the effect of routine medical evaluation (compliance) on five year survival rate of patients hospitalized due to congestive heart failure. Design. The Study design used in this study is retrospective cohort with 402 patients of newly diagnosis congestive heart failure (CHF) admitted in year 2000 to 2001 at National Cardiovascular Center - Harapan Kita, Jakarta. Results. During 5 year follow-up, 78 patients died. Survival at 1 to 5 years was in order of 88,65%, 80,11%, 72,22%, 63,75%, and 54,41%, respectively. CHF patients who did not underwent routine medical evaluation had higher prognostic of death than CHF patients who had medical evaluation routinely. By Cox regression analyses, the independent predictors of mortality were routine evaluation (FIR: 195; 95% Cl: 1.23- 3.11), low ejection fraction (HR:1,91; 95% CC:1,18-3,08), and diabetes mellitus (HR:1,85; 95%C1:1,08-3,18). Other predictors were not statistically significant, i.e: age, gender, smoking, functional class, coronary heart disease, creatinine, and the medication. Conclusion. The status or compliance is an independent predictor or survival for patients with CHF, besides low ejection fraction and diabetes mellitus These evaluation, like the other research, suggested the importance of compliance in the treatment of CHF.

Abstrak :
Latar Belakang: Penuaan merupakan proses fisiologis yang terjadi pada semua organ tubuh. Usia lanjut dan sejumlah komorbid yang terjadi seperti hipertensi, penyakit jantung koroner, diabetes melitus, penyakit paru obstruktif kronik dan penyakit ginjal kronik, merupakan faktor risiko mayor gagal jantung kongestif. Pasien usia lanjut dengan gagal jantung kongestif berisiko tinggi readmisi rumah sakit, malnutrisi, defisiensi mikronutrien, dehidrasi atau kelebihan cairan, dan mengalami penurunan ambang rasa. Pada tata laksana gagal jantung kongestif, penting untuk membatasi asupan natrium dan cairan yang dapat menyebabkan penurunan asupan nutrisi, sehingga terapi nutrisi diperlukan sejak awal perawatan. Metode: Laporan serial kasus ini memaparkan empat kasus pasien usia lanjut dengan gagal jantung kongestif, berusia 65-78 tahun dengan minimal satu penyakit komorbid yaitu hipertensi, penyakit jantung koroner, penyakit ginjal kronik, penyakit paru obstruktif kronik, dan diabetes melitus. Semua pasien memerlukan dukungan nutrisi. Dua pasien mengalami malnutrisi, satu pasien berat badan lebih dan satu pasien obes I. Masalah nutrisi yang didapatkan antara lain asupan makronutrien dan mikronutrien tidak adekuat dan komposisi nutrisi tidak seimbang selama sakit dan 24 jam terakhir, gangguan elektrolit, hiperurisemia, hiperglikemia, peningkatan kadar kolesterol LDL dan gangguan keseimbangan cairan. Terapi nutrisi gagal jantung kongestif diberikan pada semua pasien disesuaikan dengan penyakit komorbid masing-masing. Suplementasi mikronutrien dan nutrien spesifik diberikan pada keempat pasien. Pemantauan meliputi keluhan subyektif, hemodinamik, tanda dan gejala klinis, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional. Hasil: Keempat pasien menunjukkan peningkatan asupan nutrisi, perbaikan klinis berupa penurunan tekanan darah dan frekuensi nadi, serta peningkatan kapasitas fungsional. Kesimpulan: Terapi nutriso yang adekuat dapat memperbaiki kondisi klinis pasien usia lanjut dengan gagal jantung kongestif dan berbagai penyakit komorbid. ...... Background: Aging is a physiological process, which is occurs in all organs. Elderly people and various comorbidities, such as hypertension, coronary artery disease, diabetes mellitus, chronic obtructive pulmonary disease and chronic kidney disease, are major risk factors of congestive heart failure. Elderly patients with congestive heart failure are at high risk of hospital readmission, malnutrition, micronutrients deficiency, dehydration or fluid overload and decreased sense of taste. In the congestive heart failure therapy, fluid and sodium intake restriction is important, however it may result in decreased nutrition intake so that is necessary to provide early adequate nutrition therapy. Method: This serial case report describes four cases of congestive heart failure with various comorbidities in the elderly patients, aged 65-78 years old, with at least one comorbid, such as hypertension, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, and diabetes mellitus. All patients required nutrition support. Two patients classified as malnutrition, one overweight and one obese I. Nutrition problems in this serial case report are macromicronutrients intake, and nutrition composition imbalance during ill and 24 hours before hospitalized, electrolyte imbalance, hyperuricemia, hyperglycemia, elevated LDL cholesterol levels, and fluid imbalance. Nutrition therapy for congestive heart failure was given to all patients, and adjusted to the comorbidities in each patient. Micronutrients and specific nutrients supplementation were given to all patients. Monitoring include subjective complaints, hemodynamic, clinical signs and symptoms, analysis and tolerance of food intake, laboratory results, anthropometric, fluid balance, and functional capacity. Result: During monitoring in the hospital, all patients showed improved food intake, clinical outcomes, such as decreased of blood pressure, heart rate and increased of fungcional capacity. Conclusion: Adequate nutrition therapy an important role in improving clinical conditions in the elderly patients with congestive heart failure and various comorbidities.

Abstrak :

Pemantauan Terapi Obat (PTO) merupakan kegiatan yang dilakukan apoteker untuk memastikan terapi obat yang diberikan pasien aman, efektif dan rasional.  Tujuan dilakukan kegiatan PTO adalah meningkatkan efektivitas terapi dan menurunkan risiko terjadinya Reaksi Obat yang Tidak Dikehendaki (ROTD), meminimalkan biaya pengobatan serta menghormati pilihan pasien. Dengan dilakukannya kegiatan PTO, diharapkan terapi obat yang diberikan kepada pasien dapat terhindar dari risiko klinik dan meningkatkan efektivitas biaya terapi pada pasien. Beberapa kriteria pasien yang diprioritaskan untuk dilakukannya kegiatan PTO adalah pasien dengan multi penyakit yang menerima polifarmasi serta pasien dengan gangguan fungsi organ seperti hati dan ginjal. Contoh kasus yang perlu dilakukannya PTO adalah pasien Tn. IZN yang didiagnosis utama gagal jantung kongestif dan penyakit ginjal kronis serta diagnosis penyerta hiperplasia prostat yang dirawat inap di Ruang Anggrek RSUD Tarakan. Setelah dilakukannya PTO, ditemukan beberapa masalah terkait obat yang dapat diidentifikasi berdasarkan panduan PCNE dan metode Hepler and Strand yaitu indikasi tanpa terapi, interaksi obat, dosis obat berlebih, dan kesalahan pemilihan obat pada pengobatan yang diterima pasien Tn. IZN. Masalah terkait obat yang muncul dapat direkomendasikan penyelesaian berupa pemberian obat yang sesuai, pemantauan efek terapi obat melalui hasil laboratorium dan gejala yang timbulkan, pemberian jeda konsumsi obat, dan penyeseuiaan dosis sesuai tatalaksana dan kondisi pasien. ......Drug Therapy Monitoring (PTO) is an activity carried out by pharmacists to ensure drug therapy given to patients is safe, effective and rational. The purpose of PTO activities is to increase the effectiveness of therapy and reduce the risk of unwanted drug reactions (ROTD), minimize medical costs and respect patient choices. By carrying out PTO activities, it is hoped that drug therapy given to patients can avoid clinical risks and increase the cost-effectiveness of therapy for patients. Some of the criteria for prioritized patients for carrying out PTO activities are patients with multiple diseases who receive polypharmacy and patients with impaired organ function such as the liver and kidneys. An example of a case where PTO needs to be done is the patient Mr. IZN who was diagnosed primarily with congestive heart failure and chronic kidney disease as well as a concomitant diagnosis of prostatic hyperplasia who was hospitalized in the Orchid Room of Tarakan General Hospital. After the PTO was carried out, several drug-related problems were found which could be identified based on the PCNE guidelines and the Hepler and Strand method, namely indications for no therapy, drug interactions, drug overdosage, and drug selection errors in the treatment Tn's patient received. IZN. Drug-related problems that arise can be recommended for solutions in the form of administering appropriate drugs, monitoring the effects of drug therapy through laboratory results and the symptoms they cause, giving pauses in drug consumption, and adjusting doses according to the management and condition of the patient.

 

Abstrak :
Latar belakang: Gagal jantung kongestif atau congestive heart failure CHF dan diabetes melitus DM tipe 2 merupakan dua kondisi yang saling memberatkan, yaitu terjadi gangguan metabolisme yang lebih berat akibat perubahan neurohormonal, dan struktur jantung yang berpotensi memperburuk prognosis. Tatalaksana nutrisi sejak awal diagnosis sangat penting dalam mendukung proses penyembuhan pasien dan mencegah komplikasi lebih lanjut. Kasus: Dalam serial kasus ini terdapat empat pasien CHF dan DM tipe 2 dengan penyulit. Keempat pasien dengan hipertensi dan hiperurisemia, tiga pasien dengan status gizi obes, tiga pasien dengan infark miokard, satu pasien dengan unstable angina pectoris, dua pasien dengan acute kidney injury, dan satu pasien dengan chronic kidney disease. Pada awal pemeriksaan didapatkan defisiensi asupan makro- dan mikronutrien, kontrol tekanan darah dan glukosa darah yang kurang baik, retensi cairan, dan penurunan kapasitas fungsional. Tatalaksana nutrisi disesuaikan secara individual, berdasarkan kondisi klinis, hasil laboratorium dan pemeriksaan penunjang lainnya serta riwayat asupan makanan. Hasil: Seluruh pasien mengalami peningkatan toleransi asupan, perbaikan kondisi klinis, dan kapasitas fungsional. Kesimpulan: Tatalaksana nutrisi yang adekuat pada pasien CHF dan DM tipe 2 dengan penyulit dapat mendukung perbaikan kondisi klinis dan kapasitas fungsional, sehingga dapat menurunkan morbiditas dan mortalitas. ...... Background: Congestive heart failure CHF and type 2 diabetes mellitus DM are two mutually aggravating conditions, with more severe metabolic abnormalities due to changes in neurohormonal and cardiac structure which potentially worsen the prognosis. Nutritional management since early diagnosis is very important in supporting the healing process of patients and prevent further complications. Cases: Four patients were diagnosed with CHF and type 2 DM with complicating conditions. Four patients with hypertension and hyperuricemia, three patients were obese, three patients experienced myocard infarct one patient had unstable angina pectoris, two patients had acute kidney injury, and one patient had chronic kidney disease. Nutritional problems in four patients at assessment were macro and micronutrient deficiencies, uncontrolled blood pressure and blood glucose, fluid retention and declined functional capacity. Nutrition therapy were planned individually including macronutrients, micronutrients and fluid intakes, based on clinical conditions, laboratory findings, other examinations, and previous food intakes. Result: There were improvements of clinical conditions, intake tolerance, and functional capacity. Conclusion: Adequate nutrition therapy for CHF and type 2 DM patients with complicating conditions supports the improvements of clinical condition and functional capacity, decreasing morbidity and mortality rates.