Utomo, Yoseph Budi (2017) Luaran Klinis Pasien Gagal Jantung Yang Mendapat Terapi Angiotensin-Converting Enzyme (Ace) Inhibitor Dosis Optimal. Magister thesis, Universitas Brawijaya.
Abstract
Latar Belakang: Gagal jantung mengakibatkan penurunan kualitas hidup, intoleransi terhadap aktivitas, seringnya keluar masuk rumah sakit, dan peningkatan angka mortalitas. ACE inhibitor dosis optimal terbukti menurunkan angka mortalitas dan morbiditas pasien gagal jantung, namun kenyataannya hanya sepertiga dari pasien gagal jantung yang menerima ACE inhibitor dosis optimal. Tujuan: Menilai luaran klinis pemberian ACE inhibitor dosis optimal pada pasien gagal jantung yang dirawat di Rumah Sakit Saiful Anwar Malang. Metode: Penelitian ini merupakan penelitian observasional analitik dengan desain kohort prospektif, berlokasi di RS Saiful Anwar Malangpada bulan Oktober 2016 sampai Agustus 2017. Pengambilan sampel pada penelitian ini menggunakan total sampling pada semua pasien gagal jantungyang rawat inap di RS Saiful Anwar Malang, yaitu sebanyak 300 pasien. Kriteria inklusi penelitian ini adalah semua pasien gagal jantung berusia di atas 18 tahun dengan klasifikasi ACCF/AHA minimal stage C NYHA kelas I yang dirawat oleh dokter penanggung jawab pelayanan utama pasien adalah dokter spesialis jantung dan mendapat terapi ACE inhibitor. Selain itu juga pasien bersedia menandatangani informed consent penelitian. Diagnosis gagal jantung berdasarkan kriteria Framingham, dimana didapatkan 2 kriteria mayor atau 1 mayor dan 2 minor.Kriteria eksklusi adalah responden yang tidak bersedia menandatangani informed consent penelitian, tidak mendapat terapi ACE inhibitor, atau terdapat kontraindikasi pemberian ACE inhibitor.Data dilakukan coding dan dianalisis menggunakan cut off signifikansi sebesar p ≤ 0.05. Uji analisis menggunakan chi-square untuk menganalisis asosiasi antara dua variabel kategorial. Analisis dilakukan dengan software SPSS versi 22.Luaran klinis yang diukur adalah angka kematian karena penyebab kardiovaskular pada saat dirawat dan 30 hari setelah keluar dari rumah sakit dan angka rehospitalisasi pasien dalam 30 hari setelah keluar dari rumah sakit. Hasil: Dari 300 sampel penelitian, yang mendapat terapi ACE inhibitor sebanyak 171 orang. Pasien yang mendapat terapi ACE inhibitor dosis optimal saat dirawat sebanyak 29 orang. Usia rata-rata dalam penelitian ini 58 ± 12 tahun, dan 61,4% adalah laki-laki. Terdapat penurunan mortalitas saat dirawat yang signifikan pada kelompok yang mendapat ACE inhibitor dosis optimal (p = 0,009). Sedangkan mortalitas 30 hari setelah keluar dari rumah sakit dan rehospitalisasi juga menurun pada kelompok yang mendapat ACE inhibitor dosis optimal namun tidak signifikan (p = 0,375 dan p = 0,184). Ramipril dosis xiii optimal (grup carboxylat) lebih superior dibandingkan dengan captopril (grup sulfhydril) dalam penurunan angka mortalitas saat dirawat (p = 0,032). Kesimpulan: Pasien gagal jantung yang diterapi dengan ACE inhibitor dosis suboptimal memiliki resiko mortalitas dan rehospitalisasi yang lebih tinggi dibandingkan dengan yang diterapi dengan ACE inhibitor dosis optimal
English Abstract
Background: Heart failure lead to decreasing quality of life, exercise intolerance, frequent hospital admission and increasing of mortality. The optimal dose of ACE inhibitor has proven to decrease the mortality and morbidity of patients with heart failure, but in fact only one-third of patients with heart failure receive optimal dose of ACE inhibitor. Aim: To assess clinical outcome of optimal dose of ACE inhibitor in heart failure patients who are admitted at Saiful Anwar Hospital. Methods: This study is an analytic observational study with prospective cohort design, which located at Saiful Anwar Hospital Malang and conducted from October 2016 to August 2017. Sampling in this study using total sampling in all patients with heart failure who are admitted at Saiful Anwar Hospital Malang included 300 patients. The inclusion criteria in this study were all heart failure patients with age over 18 years at least stage C NYHA class I in ACCF / AHA classification of heart failure who were treated by cardiologist in charge as patient's primary care doctor. Patients were willing to sign research informed consent. Diagnosis of heart failure based on Framingham criteria, where 2 major or 1 major and 2 minor criteria are obtained. Exclusion criteria were respondents who were unwilling to sign research informed consent, did not receive ACE inhibitor, or contraindicated with ACE inhibitor. Data was coded and analyzed using cut-off significance of p ≤ 0.05. The analysis test used chi-square to analyze the association between two categorical variables. The analysis was performed with SPSS software version 22. The measured clinical outcomes wereinhospital mortality and 30 days post discharge mortality due to cardiovascular causesand rehospitalization due to heart failure within 30 days after discharge. Result: From 300 study populations, 171 persons received ACE inhibitor therapy. Patients who received optimal doses of ACE inhibitor therapy were 29 persons. The mean age in this study was 58 ± 12 years, and 61.4% were male. There was a significant decrease in inhospital mortality in the group who receiving optimal dose of ACE inhibitor (p = 0.009). Mortality 30 days post discharge and rehospitalization also decreased in the group who received optimal dose of ACE inhibitor but not significant (p = 0,375 and p = 0,184). Optimal doseof ramipril (carboxylate group) was superior to captopril (sulfhydril group) in decreasing of inhospital mortality (p = 0.032) xi Conclusion: Patients with heart failure who were treated with suboptimal dose of ACE inhibitor seemed to have greater risk of mortality and heart failure hospitalization compared with patients who were treated with optimal dose of ACE inhibitor.
| Item Type: | Thesis (Magister) |
|---|---|
| Identification Number: | TES/616.129/UTO/l/2017/041801072 |
| Uncontrolled Keywords: | ANGIOTENSIN CONVERTING ENZYNE - INHIBITORS, HEART FAILURE - PATIENTS |
| Subjects: | 600 Technology (Applied sciences) > 615 Pharmacology and therapeutics > 615.5 Therapeutics |
| Divisions: | Profesi Kedokteran > Spesialis Ilmu Penyakit Jantung dan Pembuluh Darah, Fakultas Kedokteran |
| Depositing User: | Nur Cholis |
| Date Deposited: | 13 Apr 2018 02:04 |
| Last Modified: | 21 Oct 2021 01:09 |
| URI: | http://repository.ub.ac.id/id/eprint/9405 |
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