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All Journal Indonesian Journal of Cardiology
Juzar, Dafsah Arifa
Department Of Pediatric Cardiology And Congenital Heart Disease, Faculty Of Medicine Universitas Indonesia-National Cardiovascular Center Harapan Kita
Health Professions Medicine & Pharmacology

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PERFORMA SIMPLIFIED ACUTE PHYSIOLOGY SCORE 3 SEBAGAI PREDIKTOR MORTALITAS PADA UNIT RAWAT INTENSIF KARDIOVASKULAR Akhtar Fajar Muzakkir; Dafsah Arifa Juzar; Andi Alfian Zainuddin; Dwi Yuda Herdanto; Bambang Widyantoro; Dian Zamroni; Siska Suridanda Danny; Isman Firdaus; Daniel PL Tobing; Irmalita Irmalita
Jurnal Kardiologi Indonesia Vol 39 No 4 (2018): Indonesian Journal of Cardiology: October-December 2018
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v39i4.702

Abstract

Background: Severity of illness scoring systems has gained increasing popularity in Intensive Care Units (ICUs) since 1980s. Physicians used them for predicting mortality and assessing illness severity in clinical trials. The Simplified Acute Physiology Score 3 (SAPS 3) is the only score that can predict hospital mortality within an hour of admission to ICU. Although this scoring systems has been widely used in ICUs, they have not been commonly applied in Intensive Cardiovascular Care Units (ICVCUs) since the population is quite different especially in disease subset. Therefore, the objective of this study was to evaluate the parameters in the SAPS 3 scoring system performance for predicting mortality in ICVCU population.Methods: This was an observational study with cross-sectional approach using secondary data from RAICOM (Registry of Acute and Intensive Cardiovascular Care on Outcome) taken from September 2013 – September 2014 in the ICVCU National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia. The secondary data were collected, analysed, and matched with SAPS 3 variables. All missing and invalid data were excluded. All data was processed and the SAPS 3 score was calculated in each patient. Multivariate analysis with logistic regression was conducted to evaluate the significance of the parameters in predicting mortality. Discrimination was assessed by area under the receiver operator characteristic curve (AUROC). Calibration was assessed by Hosmer-Lemeshow goodness-of-fit test through calculating the ratio of observed?to?expected numbers of deaths.Results: A total of 233 patients were included in this study and the observed hospital mortality was 16.7% (39/233). The patients enrolled were divided into survivors and nonsurvivors. Bivariate analyses of SAPS 3 variables showed intra-hospital location before ICVCU admission, use of vasoactive agents, reasons for ICVCU admission, infection, Glasgow Coma Score (GCS), creatinine level, and platelet count were significantly different between nonsurvivors than survivors (P<0.05). The SAPS 3 score was significantly higher in nonsurvivors than survivors. The AUC (95% confidence intervals [CIs]) for SAPS 3 score was 0.752 (0.669–0.835). The Hosmer?Lemeshow goodness?of?fit test for SAPS 3 demonstrated a Chi?square test score of 1.729, P = 0.943. Multivariate logistic regression was conducted for all variables that were probably correlated to prognosis. Eventually, intermediate ward as intra-hospital location before ICVCU admission was selected as an independent risk factors for predicting mortality (OR 4.165; 95% CI 1.462-11.864; P=0.008), whereas surprisingly the presence of community-acquired pneumonia (CAP) before ICVCU admission was a protective factor from hospital mortality (OR 0.224; 95% CI 0.068-0.730; P=0.013).Conclusion: Parameters in the SAPS 3 score system exhibited satisfactory performance in discrimination. In predicting hospital mortality, these parameters also showed good calibration for estimating hospital mortality. Intermediate ward as intra-hospital location before ICVCU admission appeared to be independently associated with mortality whereas patients with CAP comorbid as a protective factor against mortality. Despite the good result of this study, there are still plenty room of improvement for developing similar score in the future specifically for ICVCU population.
Age Criteria As Operative Mortality Predictor After Modified Blalock-Taussig Shunt muammar riyandi; oktavia lilyasari; dafsah arifa juzar; budi rahmat
Jurnal Kardiologi Indonesia Vol 40 No 1 (2019): Indonesian Journal of Cardiology: January-March 2019
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v40i1.763

Abstract

Background: Modified Blalock-Taussig shunt (MBTS) is considered as a simple procedure but has a considerable operative mortality rate. Patient’s characteristics who underwent MBTS in Indonesia is quite different than other country. There was no predictor of operative mortality has been identified in Indonesian.Objectives: To compare mortality rate based on age criteria and to identify mortality and morbidity predictors after MBTS procedure.Methods: A retrospectively cohort study was conducted on 400 patients who underwent MBTS at National cardiovascular center Harapan Kita (NCCHK) between January 2013 and december 2017.Results: There were 32,1% death at age ≤ 28 days, 19,9% at age 29-365 days, 3,6% at age 366-1825 days and 8% at age > 1825 days. Body weight < 3 kg, haematocrite level > 45% before procedure and activated partial thromboplastine time level (aPTT) < 60 seconds were operative mortality  predictors. Postoperative morbidity rate was 32,9%. Packed red cell  transfusion (PRC) more than 6 ml/kg, mechanical ventilator use before procedure, prostaglandin E1 use before procedure, aPTT level less than 60 seconds after procedure were identified as postoperative morbidity predictors.Conclusion: Operative mortality rate significantly different among age criteria but it was not proven as an operative mortality predictors. Body weight < 3 kg increase mortality rate and haematocrite level higher than 45% and aPTT level less than 60 seconds decrease mortality rate. Postoperative morbidity predictors were PRC transfusion more than 6ml/kg, mechanical ventilator use before procedure, prostaglandine E1 use and aPTT level less than 60 seconds.
Tantangan Penatalaksanaan STEMI di Pandemi Covid-19 Sunanto Ng; Dafsah Arifa Juzar
Jurnal Kardiologi Indonesia Vol 41 No 2 (2020): Indonesian Journal of Cardiology: April - June 2020
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1023

Abstract

The necessity of timely management of ST-elevation myocardial infarction (STEMI) is now disrupted by the Covid-19 pandemic. This paper discussed the challenge to manage STEMI in Indonesia due to Covid-19. It also discussed the alternative strategies for solution. Challenge can occur in term of the healthcare safety as well as STEMI patient safety. Healthcare safety potentially impaired by the problem of STEMI mimicry due to cardiovascular complication of Covid-10, inaccuracy of Covid-19 screening, lack of effective personal protection equipment for the healthcare and appropriate catheterisation laboratory to anticipate virus contamination. The safety of STEMI patient is potentially impaired due to prolonged ischemia time, and the risk of cross-infection. Solution for this challenge should include mass screening, rapid and accurate test to rule-out Covid-19, dual system of hospital units - Covid and non-Covid, and algorithm for triage patients with STEMI and Covid-19.
A Broken Heart Coexisting with Obstructive Coronary Artery Disease: Double Trouble Juzar, Dafsah Arifa; Putra, Bayushi Eka
Jurnal Kardiologi Indonesia Vol 43 No 4 (2022): Indonesian Journal of Cardiology: October - December 2022
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1368

Abstract

Background. Takotsubo is a syndrome characterized by transient regional systolic dysfunction of the left ventricle (LV). The most common clinical presentation mimics acute myocardial infarction without angiographic evidence of obstructive coronary artery disease or acute plaque rupture.1-3 The diagnosis and management became a challenge when it presented as atypical symptoms and significant obstructive coronary artery. Thus, this case report highlights the diagnosis and management of Takotsubo Cardiomyopathy with obstructive coronary artery disease.Case illustration. A 71 years old woman came to the emergency room with a chief complaint of dyspnea from one week ago and worsened in the last three days. The initial electrocardiogram showed slight ST-elevation, and thorax Rontgen showed the congestion and elongation of the aorta. Increased high-sensitive Cardiac Troponin T and The NT-Pro BNP levels were present, along with apical ballooning of the LV and reduced RV function. Physiological stress was found to be the death of her husband one week ago. Although the left ventriculography of this patient was classically depicted as the octopus trap, we did find obstructive coronary artery disease in the left anterior descending artery. Keywords: Takotsubo Cardiomyopathy, Uncommon presentation, Coronary artery disease, apical ballooning, acute heart failure
Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry Juzar, Dafsah Arifa; Muzakkir, Akhtar Fajar; Ilhami, Yose Ramda; Taufiq, Nahar; Astiawati, Tri; R A, I Made Junior; Pramudyo, Miftah; Priyana, Andria; Hakim, Afdhalun; Anjarwani, Setyasih; Endang, Jusup; Widyantoro, Bambang
Jurnal Kardiologi Indonesia Vol 43 No 2 (2022): Indonesian Journal of Cardiology: April - June 2022
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1406

Abstract

Background Acute coronary syndrome (ACS) is a life-threatening disorder which contributes to high morbidity and mortality in the world. Registry of ACS offers a great guidance for improvement and research. We collated a multicentre registry to gain information about demographic, management, and outcomes of ACS in Indonesia. Methods IndONEsia Acute Coronary Syndrome Registry (One ACS Registry) was a prospective nationwide multicenter registry with 14 hospitals participating in submitting data of ACS via standardized electronic case report form (eCRF). Between July 2018 and June 2019, 7634 patients with ACS were registered. This registry recorded baseline characteristics; onset, awareness, and transfer time; physical examination and additional test; diagnosis; in-hospital medications and intervention; complications; and in-hospital outcomes. Results Nearly half of patients (48.8%) were diagnosed with STE-ACS. Most prevalent risk factors were male gender, smoking, hypertension. Patients with NSTE-ACS tended to have more concomitant diseases including diabetes mellitus, dyslipidemia, prior AMI, HF, PCI, and CABG. Majority of ACS patients in our registry (89.4%) were funded by national health coverage. Antiplatelet, anticoagulant, antihypertensive, and statins were prescribed as 24-hours therapy and discharge therapy; however presription of potent P2Y12 inhibitor was low. More STE-ACS patients underwent reperfusion therapy than non-reperfusion (65.2% vs. 34.8%), and primary PCI was the most common method (45.7%). Only 21.8% STE-ACS patients underwent reperfusion strategy within 0-3 hours of onset. Invasive strategy performed in 17.6% of NSTE-ACS patients, and only 6.7% performed early (within <24 hours). Patients underwent early invasive strategy had a shorter median LoS than late invasive strategy (P<0.001). A shorter median LoS also found in intermediate and low risk patients. Mortality rate in our ACS patients was 8.9%; STE-ACS patients showed higher mortality than NSTE-ACS (11.7 vs. 6.2%). Conclusion Our registry showed a comparable proportion between STE- and NSTE-ACS patients, with male gender predominant in middle age. Both STE- and NSTE-ACS sharing the same risk factors. We need an improvement in referral time, especially in patients with STE-ACS. Evidence from our registry showed that there are two issues that need to be addressed in order to improve ACS outcomes: optimal and adequate medical treatment and invasive strategy.
The IndONEsia ICCU Registry Juzar, Dafsah Arifa; Bagaswoto, Hendry Purnasidha; Muzakkir, Akhtar Fajar; Habib, Faisal; Astiawati, Tri; Prasetya, Indra; Wirawan, Hendy; Ilhami, Yose Ramda; Djafar, Dewi Utari; Sungkar, Safir; Danny, Siska Suridanda
Jurnal Kardiologi Indonesia Vol 44 No 4 (2023): Indonesian Journal of Cardiology: October - December 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1603

Abstract

Introduction: Patients in the Intensive Cardiovascular Care Unit (ICCU) often present with cardiovascular disease (CVD) issues accompanied by various non-cardiovascular conditions. However, a widely applicable scoring system to predict patient outcomes in the ICCU is lacking. Therefore, developing and validating scores for predicting ICCU patient outcomes are warranted. The aims of the IndONEsia ICCU (One ICCU) registry include developing an epidemiological registry of ICCU patients and establishing a multicentre research network to analyse patient outcomes. Methods and results: This nationwide multicenter cohort protocol will capture data from patients receiving cardiovascular critical care treatment in 10 Indonesian hospitals with ICCU facilities. Recorded data will encompass demographic characteristics, physical examination findings at hospital and ICCU admission, diagnoses at ICCU admission, therapy, intervention, complications on days 3 and 5 of in-ICCU care, in-hospital outcomes, and 30-day outcomes. Conclusion: The One ICCU is a large, prospective registry describing the care process and advancing clinical knowledge in ICCU patients. It will serve as an investigational platform for predicting the mortality of ICCU patients.
Timeframe Factors of Door-to-Device Time During Pandemic Situation in a Tertiary Cardiovascular Centre in Indonesia Firdaus, Isman; Juzar, Dafsah Arifa; Dewanggi, Bunga; Nurfitri, Syafira; Utarini, Adi; Djasri, Hanevi
Jurnal Kardiologi Indonesia Vol 44 No 4 (2023): Indonesian Journal of Cardiology: October - December 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1649

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has greatly affected every aspect of life, especially in the field of cardiovascular services. This creates many challenges in the treatment of highly time-sensitive and potentially lethal conditions such as ST-elevation acute myocardial infarction (STEMI). STEMI patients at high risk for COVID-19 are recommended to be evaluated with additional testing for COVID-19 and possibly require respiratory support, all of which can delay Door-to-device time (DTDT). Objective: In this study, we sought to determine the DTDT for primary percutaneous coronary intervention (PCI) in acute STEMI, the various timeframes influencing the DTDT, and which time factor has the most significant correlation to DTDT in the COVID-19 pandemic era. Methods: A longitudinal retrospective study was conducted at the largest tertiary referral hospital in Indonesia from March 2020 to February 2021. The following timeframes were measured during the study: Door-to-Diagnosis Time [Δt1], Diagnosis-to-Activation Time [Δt2], Informed Consent Time [Δt3], Preparation at Emergency Room (ER) Time [Δt4], Preparation at Catheterization Laboratory Time [Δt6], and PCI Initiation-to-Balloon Time [Δt7]. Spearman’s correlation (ρ) was used to ascertain the correlation among time factors. Results: 238 patients met the inclusion criteria of this study. The observed DTDT was 110 [47 – 437] minutes. Of the variables, DTDT had a strong positive correlation with preparation at the ER time (median 28,0 (1 – 344) minutes; r = 0.702; p-value < 0.0001). Conclusion: This study sheds light on preparation at the ER time as a significant influencing factor for Door-to-device time in the COVID-19 pandemic era.
Co-Authors Adi Utarini Akhtar Fajar Muzakkir Andi Alfian Zainuddin Andria Priyana Anjarwani, Setyasih Astiawati, Tri Bambang Widyantoro Bayushi Eka Putra budi rahmat Daniel PL Tobing Dewanggi, Bunga Dewi Utari Djafar, Dewi Utari Dian Zamroni Dwi Yuda Herdanto Endang, Jusup Habib, Faisal Hakim, Afdhalun Hanevi Djasri Hendry Purnasidha Bagaswoto Ilhami, Yose Ramda Indra Prasetya Irmalita Irmalita Isman Firdaus muammar riyandi Muzakkir, Akhtar Fajar Nahar Taufiq, Nahar Nurfitri, Syafira oktavia lilyasari Pramudyo, Miftah R A, I Made Junior Siska Suridanda Danny Siska Suridanda Danny Sunanto Ng Sungkar, Safir Wirawan, Hendy