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All Journal Indonesian Journal of Cardiology Heart Science Journal Narra J
Astiawati, Tri
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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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.
Validation of Self-Assessment-Based Chest Pain Algorithm (DETAK) as An Early Identification Tool for Acute Coronary Syndrome Nugraha, Krishna Ari; Rohman, Mohammad Saifur; Rahimah, Anna Fuji; Anjarwani, Setyasih; Rizal, Ardian; Astiawati, Tri; Adi, Andi Wahjono; Haryati, Lina
Heart Science Journal Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.5

Abstract

BackgroundThe most common reason of prehospital delay in ACS patients is inability to pay attention to symptoms in order to act fast and effectively. Patient oriented machine learning algorithms has the opportunity to reduce the total ischemic time, that determines the clinical outcome of ACS patients.AimAssessing the accuracy of the chest pain self-assessment algorithm (DETAK) in identifying ACS.MethodThis study included seven hospitals, five PCI capable hospitals and two of non-PCI capable hospitals. The study was conducted from August 2021 to June 2022. The study included all patients with chest pain who visited the hospital and used the DETAK algorithm. Patients were interviewed after being confirmed hemodynamically stable. Patients with UAP, as well as those who died or declined to participate in this study were excluded. The area under the curve receiver operating characteristic (AUROC) was used to verify DETAK's performance in identifying SKA. We compare the DETAK algorithm's diagnosis with the definitive diagnostic based on ECG and/or troponin results.ResultsA total of 539 patients (mean age 58 years) with a higher proportion of male patients (n=424). An AUC value of 0.854 was obtained, where the cut of point accuracy of DETAK in identifying ACS for the entire sample had a sensitivity of 89.5% and a specificity of 81.2%. The algorithm's specificity decreased in certain subgroups, including type 2 diabetes (79.4%), women (77.3%), and hypertensive patients (80.9%). Algorithm reliability test obtained moderate to strong level of agreement values.ConclusionDETAK's self-assessment-based chest pain algorithm offers an excellent diagnostic performance in early identification of ACS.
Impact of Strict and Lenient Heart Rate Control on Six-Minute Walk Test and Quality of Life in Atrial-Fibrillation Patients with Rheumatic Mitral Stenosis : Randomized Control Trial Dwigustiningrum, Nur Kaputrin; Rizal, Ardian; Putri, Valerinna Yogibuana Swastika; Rahimah, Anna Fuji; Rohman, Mohammad Saifur; Wikananda, Adhika Prastya; Waranugraha, Yoga; Astiawati, Tri; Laitupa, Fitranti Suciati
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.8

Abstract

Background: Recent studies showed no outcome difference between strict and lenient rate control in the general Atrial Fibrillation (AF) population. However, for AF and Rheumatic Mitral Stenosis (RMS) patients, evidences were lacking.Objective: To assess the impact of strict and lenient heart rate control on the Six-Minute Walk Test (SMWT) and Health Related Quality of Life (HRQoL) in patients with AF and RMS.Material and Methods: A prospective multicenter trial across tertiary hospitals in East Java assessed strict and lenient heart rate control's impact on the SMWT and HRQoL in AF and RMS patients. Sixty-one participants were randomized into strict and lenient groups over six months from March to August 2023. Medications were adjusted to achieve target heart rates, and HRQoL was assessed using SF-36 and SMWT at baseline and three months post-target heart rate attainment.Result: In our study, 29 patients were under strict heart rate control, and 32 were under lenient control. We found a decrease in HRQoL across all subscales, with significant differences observed in general health perception and physical function among those under strict control (p=0.002 and 0.03, respectively). However, no significant disparity was found in the SMWT distance difference between lenient and strict groups (p=0.529), nor in METs (p=0.326).Conclusion: In the study, lenient heart rate control demonstrates significant effects on the general health perception and physical function subscales compared to strict heart rate control. 
Diagnostic Test for Estimation of Plasma Volume on Assessment of Congestive Status in Acute Heart Failure Patients at Saiful Anwar General Hospital Pamuna, Oktafin Srywati; Prasetya, Indra; Astiawati, Tri; Rohman, Mohammad Saifur; Kurnianingsih, Novi
Heart Science Journal Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.3

Abstract

BackgroundHeart failure is a severe health issue with high death and morbidity rates globally, including in Indonesia. Congestion is the main symptom of acute heart failure. B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are well-known markers to confirm the condition. Plasma volume estimation (ePVS)is one of the procedures currently being developed to assess a patient's congestive status at a lower cost. MethodsThis is descriptive observational research with a cross-sectional study method that included all patients with acute heart failure between May 2019-February 2022. Baseline characteristics, medication history, and echocardiography were also included in the statistical analysis. We used univariate and multivariate analysis to assess the effect of each variable on the patient's congestive condition. A diagnostic test of plasma volume estimation was carried out using Receiver Operating Characteristics (ROC) Analysis compared to NT pro-BNP as the gold standard.   Results A total of 506 subjects were diagnosed with acute heart failure at Dr. Saiful Anwar Malang Hospital, who met the inclusion and exclusion criteria. The mean age was older in congestive patients with 62.5% being male. Patients with congestive conditions have a lower ejection fraction with a higher estimated right atrial pressure from echocardiography. The estimation plasma volume status was also higher in congestive conditions (6,90 vs 3,5). The ePVS from ROC analysis has a good diagnostic value with a sensitivity of 91, 7% and specificity of 92,6%. ConclusionThe estimation of plasma volume status has a good sensitivity and specificity value to assess congestive status in patients with acute heart failure who are fluid-overloaded. 
Effect Of Combination Decafeinated Green Tea and Green Coffee In Reducing Cholesterol Levels In Patients With Metabolic Syndrome Alfata, Fandy Hazzy; Rohman, Mohammad Saifur; Astiawati, Tri; Tjahjono, Cholid Tri; Martini, Heny
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.4

Abstract

Background: Green tea and green coffee are natural ingredients that improve cholesterol levels. Combining the two in experimental animal studies provides more significant benefits when compared to single administration in reducing cholesterol levels.Objective: This study aimed to determine the effect of decaffeinated green tea and green coffee as adjuvant treatments in reducing blood cholesterol levels.Methods: This randomized controlled trial included 90 metabolic syndrome patients determined according to the IDF criteria for Asian people aged 50–70. All subjects received atorvastatin 20 mg and were divided into three groups. Participants in Group 1 received decaffeinated green tea and green coffee 2.5 grams twice daily, Group 2 received 5 grams daily, and Group 3 received a placebo. The total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride levels were measured at the beginning and the end of the study.Results: At 90 days, after administration of the extract of decaffeinated green tea and green coffee, we found that the concentration of total cholesterol in Group 1 and Group 2 was significantly reduced compared to the placebo (-50 ± 6.1 vs. -62.8 ± 5.9 vs. -22.5 ± 5.8 mg/dL; p= <0.05). But there was no significant difference in reduction of total cholesterol levels between the first and second groups. The other parameters also decreased, but not significantly compared to the placebo group.Conclusion: Administration of a combination of decaffeinated green tea extract and green coffee as an adjunctive therapy can reduce the average total  cholesterol, LDL, HDL, and triglyceride levels more than placebo, but only total cholesterol has a significant difference compared to other cholesterol  components.
Hypocapnia and its relationship with in-hospital mortality in acute heart failure patients: Insights from the Indonesian multicenter ICCU registry Prasetya, Indra; Afifah, Yuri; Anjarwani, Setyasih; Juzar, Dafsah A.; Bagaswoto, Hendry P.; Muzakkir, Akhtar F.; Habib, Faisal; Astiawati, Tri; Wirawan, Hendy; Ilhami, Yose R.; Djafar, Dewi U.; Sungkar, Safir; Danny, Siska S.; Rohman, Mohammad S.
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.1638

Abstract

Acute heart failure (AHF) presents serious risks for hospitalized patients. The aim of this study was to explore the relationship between arterial partial pressure of carbon dioxide (PaCO2) levels and outcomes in AHF patients admitted to the intensive cardiovascular care unit (ICCU), utilizing data from the IndONEsia ICCU Registry (One ICCU Registry). A multicenter retrospective observational study was performed covering data between August 2021-2023. Participants were categorized by PaCO2 levels: hypocapnia (<35 mmHg), normocapnia (35–45 mmHg), and hypercapnia (>45 mmHg). The primary outcomes included ICCU mortality, in-hospital mortality, and 30-day mortality, whereas the length of the stays in the ICCU or hospital and ventilation requirement were set as the secondary outcomes. Mortality risks were assessed using Cox proportional hazards models. Of the 1,870 patients, 1,102 (58.96%) had hypocapnia, 645 (34.5%) had normocapnia, and 123 (6.5%) had hypercapnia. Hypocapnia patients had significantly higher ICCU, in-hospital, and at 30-day mortality rates compared to normocapnic patients (all p<0.001), along with longer lengths of stay in ICCU and in hospital (p<0.001). Hypocapnia significantly increased noninvasive and mechanical ventilation requirement compared to normocapnia patients. Multivariate analysis identified factors impacting patients’ survival, including age, treatment with angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARBs) drugs, and severity scores such as the quick sequential organ failure assessment (qSOFA) and simplified acute physiology score II (SAPS II). In conclusion, hypocapnia in AHF patients could increase in-hospital, ICU and 30-days mortality rates and length of hospital stays, as well as noninvasive and mechanical ventilation requirements.
Comparative predictive value of APACHE-II, SAPS-II and GRACE scores for mortality in acute coronary syndrome (ACS) patients: Evidence from Indonesia intensive cardiovascular care unit registry Prasetya, Indra; Hakim, Dennis I.; Anjarwani, Setyasih; Bagaswoto, Hendry P.; Muzakkir, Akhtar F.; Habib, Faisal; Astiawati, Tri; Wirawan, Hendy; Ilhami, Yose R.; Djafar, Dewi U.; Sungkar, Safir; Danny, Siska S.; Juzar, Dafsah A.
Narra J Vol. 5 No. 1 (2025): April 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i1.1911

Abstract

The Global Registry of Acute Coronary Events (GRACE) score is acknowledged for its ability to predict in-hospital mortality among patients with acute coronary syndrome (ACS). However, intensive care physicians often employ general prognostic scores such as Acute Physiologic and Chronic Health Evaluation II (APACHE-II) and Simplified Acute Physiology Score II (SAPS-II) to predict the mortality of ACS patients. However, their predictive values are not well-determined in predicting mortality in ACS treated in the cardiovascular care unit (CVCU). The aim of this study was to evaluate the performance of APACHE-II and SAPS-II scores in comparison with GRACE scores in predicting the CVCU mortality and in-hospital mortality of ACS patients admitted to CVCU. A multicenter retrospective cohort study was conducted using data from a registry of patients admitted to 10 hospitals in Indonesia between August 2021 and July 2023. This study evaluated the APACHE-II, SAPS-II, and GRACE scores for patients with ACS upon admission to CVCU. The area under the curve (AUC) of the receiver operating characteristic (ROC) was utilized to assess the discriminative ability for predicting mortality. Among the 12,950 admitted patients, 9,040 were diagnosed with ACS, and 6,490 patients were included in the final analysis. All three scoring systems had relatively good discriminative ability to predict CVCU mortality with APACHE-II having better results (AUC: 0.771; sensitivity: 63.9%; specificity: 78.7%) compared to GRACE (AUC: 0.726; sensitivity: 61.7%; specificity: 73.2%) and SAPS-II (AUC: 0.655; sensitivity: 38.9%; specificity: 85.2%). To predict in-hospital mortality, APACHE-II had better results (AUC: 0.815; sensitivity: 68.7%; specificity: 80.4%) compared to GRACE (AUC: 0.769; sensitivity: 64.6%; specificity: 77.5%) and SAPS-II (AUC: 0.683; sensitivity: 41.8%; specificity: 86.2%). APACHE-II had the best single risk factor for CVCU mortality (odds ratio (OR): 1.198; 95% confidence interval (CI): 1.181–1.214) and in-hospital mortality (OR: 1.259; 95%CI: 1.240–1.279). In conclusion, APACHE-II, SAPS-II, and GRACE scores moderately predict CVCU and in-hospital mortalities, with the APACHE-II score exhibiting the highest predictive capability in ACS patients admitted to CVCU.
Effect Of Combination Decafeinated Green Tea and Green Coffee In Reducing Cholesterol Levels In Patients With Metabolic Syndrome Alfata, Fandy Hazzy; Rohman, Mohammad Saifur; Astiawati, Tri; Tjahjono, Cholid Tri; Martini, Heny
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.4

Abstract

Background: Green tea and green coffee are natural ingredients that improve cholesterol levels. Combining the two in experimental animal studies provides more significant benefits when compared to single administration in reducing cholesterol levels.Objective: This study aimed to determine the effect of decaffeinated green tea and green coffee as adjuvant treatments in reducing blood cholesterol levels.Methods: This randomized controlled trial included 90 metabolic syndrome patients determined according to the IDF criteria for Asian people aged 50–70. All subjects received atorvastatin 20 mg and were divided into three groups. Participants in Group 1 received decaffeinated green tea and green coffee 2.5 grams twice daily, Group 2 received 5 grams daily, and Group 3 received a placebo. The total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride levels were measured at the beginning and the end of the study.Results: At 90 days, after administration of the extract of decaffeinated green tea and green coffee, we found that the concentration of total cholesterol in Group 1 and Group 2 was significantly reduced compared to the placebo (-50 ± 6.1 vs. -62.8 ± 5.9 vs. -22.5 ± 5.8 mg/dL; p= <0.05). But there was no significant difference in reduction of total cholesterol levels between the first and second groups. The other parameters also decreased, but not significantly compared to the placebo group.Conclusion: Administration of a combination of decaffeinated green tea extract and green coffee as an adjunctive therapy can reduce the average total  cholesterol, LDL, HDL, and triglyceride levels more than placebo, but only total cholesterol has a significant difference compared to other cholesterol  components.
Co-Authors Adi, Andi Wahjono Afifah, Yuri Alfata, Fandy Hazzy Andria Priyana Anjarwani, Setyasih Bagaswoto, Hendry P. Bambang Widyantoro Cholid Tri Tjahjono Danny, Siska S. Dewi U. Djafar, Dewi U. Dewi Utari Djafar, Dewi Utari Dwigustiningrum, Nur Kaputrin Endang, Jusup Habib, Faisal Hakim, Afdhalun Hakim, Dennis I. Haryati, Lina Hendry Purnasidha Bagaswoto Ilhami, Yose R. Ilhami, Yose Ramda Indra Prasetya Juzar, Dafsah A. Juzar, Dafsah Arifa Kurnianingsih, Novi Laitupa, Fitranti Suciati Martini, Heny Mohammad S. Rohman Mohammad Saifur Rohman Muzakkir, Akhtar F. Muzakkir, Akhtar Fajar Nahar Taufiq, Nahar Nugraha, Krishna Ari Pamuna, Oktafin Srywati Pramudyo, Miftah Putri, Valerinna Yogibuana Swastika R A, I Made Junior Rahimah, Anna Fuji Rizal, Ardian Siska Suridanda Danny Sungkar, Safir Wikananda, Adhika Prastya Wirawan, Hendy Yoga Waranugraha