SKRIPSI - Universitas Muhammadiyah Malangeprints.umm.ac.id/46841/1/PENDAHULUAN.pdf · B terapi yang...
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SKRIPSI
AULIA TAMARA
STUDI PENGGUNAAN KOMBINASI DIGOXIN
DAN FUROSEMID PADA PASIEN GAGAL
JANTUNG (Penelitian Dilakukan di Ruang Rawat
Inap RSUD Kabupaten Kediri)
PROGRAM STUDI FARMASI
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MALANG
2018
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KATA PENGANTAR
Bismillahirrahmanirrohim
Assalamu’alaikum warohmatullohi wabarakatuh
Puji syukur tercurahkan kepada Allah SWT, Tuhan semesta alam karena
berkat rahmat serta ridlo-Nya, penulis dapat menyelesaikan skripsi yang berjudul
”STUDI PENGGUNAAN KOMBINASI DIGOXIN DAN FUROSEMID
PADA PASIEN GAGAL JANTUNG (Penelitian dilakukan di Ruang Rawat
Inap RSUD Kabupaten Kediri”
Skripsi ini diajukan untuk memenuhi syarat mencapai gelar Sarjana Farmasi
pada program Studi Farmasi Universitas Muhammadiyah Malang. Dalam
penyusunan skripsi ini penulis tidak lepas dari peran penting pembimbing dan
bantuan dari seluruh pihak. Oleh karena itu, dengan segala kerendahan hati, penulis
ingin mengucapkan terima kasih kepada :
1. Allah SWT, Tuhan semesta alam yanng memberikan rahmat, nikmat dan
hidayahNya kepada umatnya, Rosulullah SAW, yang sudah menuntun kita
menuju jalan yang lurus.
2. Bapak Faqih Ruhyanudin, M.Kep., Sp.Kep.KMB. selaku Dekan Fakultas
Ilmu Kesehatan Universitas Muhammadiyah Malang yang telah memberikan
kesempatan kepada penulis belajar di Fakultas Ilmu Kesehatan Universitas
Muhammadiyah Malang.
3. Direktur RSUD Kabupaten Kediri beserta jajarannya yang telah memberikan
kesempatan pada penulis untuk melakukan penelitian di RSUD Kabupaten
Kediri.
4. Staf pegawai Rekam Medik Kesehatan RSUD Kabupaten Kediri yang telah
banyak membantu dalam proses pengambilan data skripsi.
5. Bapak Drs. Didik Hasmono, Apt., Ms. selaku dosen pembimbing I, ibu Dra.
Lilik Yusetyani, Apt., Sp.FRS. selaku dosen pembimbing yang telah memberi
pengarahan dan motivasi sampai terselesaikan skripsi ini.
6. Ibu Hidajah Rachmawati, S.Si., Apt., Sp.FRS. selaku dosen penguji I dan ibu
Dra. Uswatun Chasanah., M.Kes., Apt. selaku penguji II yang telah
memberikan banyak saran dan masukan demi kesempurnaan skripsi ini.
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7. Kedua orangtua saya tercinta, Bapak Drs. H. Ma’ruf Ach. Tadjuddin dan Ibu
Hj. Nihayatus Sholiha yang selalu memberikan motivasi, doa, pengorbanan,
serta kerja kerasnya demi keberhasilan dan kesuksesan putrinya. Serta adik
saya M. Nashih Taufiqie.
8. Sahabat terdekat saya Muhammad Ghozali, S.Pd. dan Kholidiyah Fadlillah,
S.Psi. yang telah menjadi sahabat baik dan selalu memberikan motivasi dan
dorongan hingga skripsi ini bisa selesai.
9. Teman-teman ‘uye squad’ dan teman perjuangan skripsi anita hariati, jean
mona, fitri arinda, Dwi Esti Vania, Alfira aryanti, Devi silvidia dan qardina
annisa yang selalu memberikan semangat dalam pengerjaan skripsi ini.
10. Teman-teman farmasi 2014 “OCTOPHAR”, khususnya farmasi C
“FARMASI KECE” terima kasih atas 4 tahun yang kita lewati bersama di
dalam menuntut ilmu dalam suka dan cita.
11. Untuk semua pihak yang belum disebutkan namanya, penulis mohon maaf
dan terima kasih yang sebesar-besarnya. Semua keberhasilan dalam
penyelesaian skripsi ini tidak luput dari bantuan dan doa kalian semua.
Semoga amalan kalian mendapat imbalan Allah SWT. Penulis juga
menyadari bahwa skripsi ini jauh dari kesempurnaan, oleh karena itu penulis
mengharapkan kritik dan saran yang membangun dari pembaca demi kebaikan
skripsi ini, semoga hasil penulisan ini dapat memberikan manfaat bagi pembaca dan
penelitian selanjutnya, aamiinn.
Wassalamu’alaikum warohmatullahi wabarakatuh
Malang, 23 Juli 2018
Penyusun
(Aulia Tamara)
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RINGKASAN
STUDI PENGGUNAAN KOMBINASI DIGOKSIN DAN FUROSEMID
PADA PASIEN GAGAL JANTUNG
(Penelitian dilakukan di Ruang Rawat Inap RSUD Kabupaten Kediri)
Gagal jantung (HF) adalah sindrom klinis progresif yang disebabkan oleh
ketidakmampuan jantung memompa cukup darah untuk memenuhi kebutuhan
metabolisme tubuh. HF bisa dihasilkan dari apapun gangguan yang mengurangi
pengisian ventrikel (disfungsi diastolik) dan / atau miokard kontraktilitas (disfungsi
sistolik). Manifestasi klinis dari gagal jantung yaitu dispnea, ortopneu, Dispneu
Nokturnal Paroksimalis (PND), Edema perifer. Secara Umum, New York Heart
Association (NYHA) mengklasifikasikan gagal jantung sesuai tingkat keparahan
gejala untuk membatasi aktifitas fisik (NYHA, 2016). Kemudian American Heart
Association (AHA) mengklasifikasikan sesuai kondisi untuk menyediakan
kerangka kerja yang komprehensif, untuk mengevaluasi, mencegah dan mengobati
gagal jantung. Ada beberapa macam gagal jantung yaitu Gagal jantung kiri, Gagal
jantung kanan, gagal jantung kongestif, gagal jantung curah tinggi, gagal jantung
curah rendah. Terdapat beberapa faktor risiko dari gagal jantung diantaranya
hipertensi, diabetes melitus, dislipidemia, inaktifitas fisik, obesitas, merokok
namun terdapat beberapa faktor risiko yang tidak dapat diubah yaitu usia, jenis
kelamin, riwayat keluarga. Tujuan dari pengobatan gagal jantung adalah
Meningkatkan kualitas hidup, mencegah memburuknya fungsi jantung
(mengurangi beban kerja jantung) mengurangi gejala (pengurangan overload dan
meningkatkan kontraktilitas miokard), mencegah atau meminimalkan rawat inap,
memperlambat perkembangan penyakit, dan memperpanjang kelangsungan hidup.
Sesuai dengan American Heart Association (AHA) pada kelas A terapi yang di
sarankan adalah dengan melakukan kontrol terhadap faktor resiko dari gagal
jantung, obat-obatan yang di sarankan yaitu golongan ACE (Angiotensin
Converting Enzyne) inhibitor, dan ARB (Angiotensin Reseptor Blocker). Pada kelas
B terapi yang disarankan yaitu obat-obatan ACE (Angiotensin Converting Enzyne)
inhibitor, ARB (Angiotensin Reseptor Blocker), dan β-Blocker. Kemudian pada
kelas C, terapi yang disarankan ACE (Angiotensin Converting Enzyne) inhibitor,
ARB (Angiotensin Reseptor Blocker), β-Blocker, Digoksin, Diuretik, dan ISDN.
Serta terapi pada kelas D yaitu adanya dukungan sirkulasi mekanik, IV (Intra Vena)
Inotropik Positif, dan transplantasi jantung.
Tujuan penelitian ini adalah untuk Mengetahui pola penggunaan kombinasi
Digoksin dengan Furosemid terkait jenis sediaan, dosis, bentuk sediaan, interval
pemberian, lama pemberian, frekuensi dan rute pemberian.
Metode penelitian ini adalah penelitian observasional dengan rancangan
penelitian secara deskriptif dan metode pengambilan data secara retrospektif yang
didasarkan pada rekam medik kesehatan pasien stroke iskemik yang diambil dan
diolah dari Ruang Rawat Inap Rumah Sakit Umum Daerah Kabupaten Kediri pada
periode Januari hingga desember 2017. Diperoleh data sampel sesuai kriteria inklusi sebanyak 26 pasien.
Hasil penelitian menunjukkan pasien gagal jantung lebih banyak laki-laki
sebanyak 14 orang (54%) dibandingkan wanita sebanyak 12 orang (46%). Usia
paling banyak terjadinya gagal jantung ada pada rentang 61-70 tahun sebanyak 12
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orang (46%) dan usia >70 tahun sebanyak 9 orang (35%). Status penjaminan pasien
paling banyak yaitu pasien BPJS sebanyak 19 orang (81%) sedangkan pasien umum
sebanyak 5 orang (19%). Diagnosa lain pada pasien gagal jantung di RSUD
Kabupaten kediri paling banyak adalah dyspnea sebanyak 10 orang (38%). Lama
penggunaan kombinasi digoksin dan furosemid paling banyak adalah 2-3 hari
sebanyak 12 orang (46%). Lama perawatan pasien gagal jantung di RSUD
Kabupaten Kediri yang dirawat dengan waktu paling lama >9 hari ada 1 orang (4%).
Kondisi keluar rumah sakit (KRS) pada pasien gagal jantung setelah dirawat di
RSUD Kabupaten Kediri terbanyak adalah pulang dengan persetujuan dokter
dimana terjadi perbaikan pada pasien (81%).
Kesimpulan yang didapatkan yaitu, penggunaan terapi kombinasi digoxin dan
furosemid di RSUD Kabupaten kediri umumnya dikombinasikan dengan diuretik
lain yaitu Spironolakton. Pola kombinasi yang paling banyak digunakan adalah
digoxin (1x0,25mg) po + furosemid (3x20mg) iv + spironolakton (1x25mg) po
yaitu sebanyak 15 pasien (48%). Pola switching paling banyak adalah digoxin
(1x0,25mg) po + furosemid (1x20mg) iv + spironolacton (1x25mg) po → digoxin
(1x0,25mg) p0 + furosemid (1x40mg) po + spironolacton (1x25mg) po yaitu
sebanyak 3 pasien (27%).
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DAFTAR ISI
Halaman
DAFTAR ISI ........................................................................................................... x
DAFTAR TABEL ................................................................................................. xv
DAFTAR GAMBAR ........................................................................................... xvi
DAFTAR LAMPIRAN ....................................................................................... xvii
DAFTAR SINGKATAN....................................................................................xviii
BAB I PENDAHULUAN ....................................................................................... 1
1.1. Latar Belakang .......................................................................................... 1
1.2. Rumusan Masalah ..................................................................................... 4
1.3. Tujuan Penelitian ...................................................................................... 4
1.4. Manfaat Penelitian .................................................................................... 5
BAB II TINJAUAN PUSTAKA ............................................................................. 6
2.1. Jantung ...................................................................................................... 6
2.2. Definisi Gagal Jantung .............................................................................. 6
2.3. Epidemiologi Gagal Jantung ..................................................................... 7
2.4. Etiologi Gagal Jantung .............................................................................. 8
2.4.1. Disfungsi sistolik ................................................................................... 9
2.4.1.1. Kardiomiopati hipertrofik ................................................................... 9
2.4.1.2. Hipertrofi Ventrikel............................................................................. 9
2.4.1.3. Kelebihan Beban Tekanan .................................................................. 9
2.4.1.4. Kelebihan Beban Volume ................................................................... 9
2.4.1.5. Penyakit Miokardium ........................................................................ 10
2.4.2. Kegagalan Diastolik ............................................................................. 10
2.4.3. Kondisi dan Penyakit lain .................................................................... 10
2.4.3.1. Aritmia .............................................................................................. 10
2.4.3.2. Penyakit Jantung Bawaan ................................................................. 11
2.5. Klasifikasi Gagal Jantung ....................................................................... 11
2.6. Macam-macam Gagal Jantung ................................................................ 12
2.6.1. Gagal Jantung Kiri .......................................................................... 12
2.6.2. Gagal Jantung Kanan ...................................................................... 12
2.6.3. Gagal Jantung Kongestif ................................................................. 13
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2.6.4. Gagal Jantung Curah Tinggi ........................................................... 13
2.6.5. Gagal Jantung Curah Rendah .......................................................... 13
2.7. Faktor Risiko Gagal Jantung ................................................................... 13
2.7.1. Faktor Risiko yang Dapat Dirubah ................................................. 14
2.7.1.1. Hipertensi ......................................................................................... 14
2.7.1.2. Diabetes Mellitus ............................................................................. 15
2.7.1.3. Dislipidemia ..................................................................................... 15
2.7.1.4. Inaktivitas Fisik ................................................................................ 15
2.7.1.5. Obesitas ............................................................................................ 15
2.7.1.6. Merokok ........................................................................................... 16
2.7.2. Faktor Risiko yang Tidak Dapat Dirubah ....................................... 16
2.7.2.1. Usia .................................................................................................. 16
2.7.2.2. Jenis Kelamin ................................................................................... 16
2.7.2.3. Riwayat Keluarga ............................................................................ 16
2.8. Patofisiologi gagal jantung ..................................................................... 17
2.8.1. Mekanisme Kompensasi ................................................................. 18
2.8.1.1. Aktivasi Neurohormonal .................................................................. 19
2.8.1.1.1. Sistem Saraf Adrenergik ....................................................... 19
2.8.1.1.2. Sistem Renin Angiotensin-Aldosteron.................................. 20
2.8.1.2. Remodeling Miokard ....................................................................... 20
2.8.1.3. Hipertrofi Ventrikel ......................................................................... 21
2.8.1.4. Mekanisme Frank Starling ............................................................... 22
2.9 Manifestasi Klinis Gagal Jantung ........................................................... 22
2.9.1. Dispnea ................................................................................................ 22
2.9.2. Ortopneu .............................................................................................. 22
2.9.3. Dispneu Nokturnal Paroksimalis (PND) ............................................. 22
2.9.4. Edema Perifer ...................................................................................... 23
2.10. Diagnosa dan Pemeriksaan Klinis Gagal Jantung .................................. 24
2.10.1. Elektrokardiografi ........................................................................... 24
2.10.2. Foto Toraks ..................................................................................... 25
2.10.3. Ekokardiografi................................................................................. 25
2.10.4. Magnetic Resonance Imaging (MRI) .............................................. 25
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2.10.5. Pemeriksaan Laboratorium ............................................................. 25
2.10.5.1. Pemeriksaan BNP (B-type Natriuretic Peptide) .............................. 26
2.10.5.2. Troponin I atau T ............................................................................. 26
2.10.5.3. CK-MB ............................................................................................ 26
2.10.5.4. Kolesterol ......................................................................................... 27
2.11. Penatalaksanaan Terapi Gagal Jantung ................................................... 27
2.11.1. Terapi Non Farmakologi ................................................................. 28
2.11.2. Terapi Farmakologi ......................................................................... 28
2.11.2.1. Diuretik ............................................................................................ 29
2.11.2.1.1. Diuretik Loop ...................................................................... 30
2.11.2.1.1.1. Furosemid ...................................................................... 31
2.11.2.1.1.2. Farmakokinetik .............................................................. 31
2.11.2.1.1.3. Farmakodinamik ............................................................ 32
2.11.2.1.1.4. Efek Samping ................................................................. 32
2.11.2.1.1.5. Interaksi ......................................................................... 33
2.11.2.1.1.6. Penggunaan furosemid pada gagal jantung ................... 34
2.11.2.1.1.7. Sediaan Furosemid di Indonesia .................................... 35
2.11.2.1.2. Diuretik Tiazid .................................................................... 39
2.11.2.1.3. Diuretik Hemat Kalium ....................................................... 40
2.11.2.2. Obat Inotropik .................................................................................. 40
2.11.2.2.1. Digoxin ................................................................................ 42
2.11.2.2.1.1. Farmakokinetik .............................................................. 42
2.11.2.2.1.2. Farmakodinamik ............................................................ 43
2.11.2.2.1.3. Efek Samping ................................................................. 44
2.11.2.2.1.4. Interaksi Digoxin ........................................................... 45
2.11.2.2.1.5. Penggunaan Digoxin pada Gagal Jantung ..................... 46
2.11.2.2.1.6. Sediaan Digoxin di Indonesia ....................................... .47
2.11.2.2.2. Inotropik Lain ...................................................................... 48
2.11.2.3. Penggunaan Kombinasi Digoxin dan Fursosemid Pada Gagal
Jantung....................................................................................................... 49
2.11.2.4. Antagonis Aldosteron ...................................................................... 49
2.11.2.5. Angiotensin Converting Enzyme Inhibitor (ACEI) ......................... 50
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2.11.2.6. Angiotensin Reseptor Blocker (ARB) ............................................. 51
2.11.2.7. Calsium Canal Blocker (CCB) ........................................................ 53
2.11.2.8. β-Blocker ......................................................................................... 53
BAB III KERANGKA KONSEPTUAL ............................................................... 55
3.1. Kerangka Konseptual .............................................................................. 55
3.2 Kerangka Operasional............................................................................56
BAB IV METODE PENELITIAN ....................................................................... 57
4.1. Rancangan Penelitian .............................................................................. 57
4.2. Populasi dan Sampel ............................................................................... 57
4.2.1. Populasi ........................................................................................... 57
4.2.2. Sampel ............................................................................................. 57
4.2.3. Kriteria Inklusi ................................................................................ 57
4.2.4. Kriteria Eksklusi.............................................................................. 57
4.3. Bahan Penelitian ..................................................................................... 57
4.4. Instrumen Penelitian ............................................................................... 58
4.5. Tempat dan Waktu Penelitiab ................................................................. 58
4.6. Metode Pengumpulan Data ..................................................................... 58
4.7. Analisa Data ............................................................................................ 58
4.8. Definisi Operasional ............................................................................... 58
BAB V HASIL PENELITIAN.............................................................................. 61
5.1 Data Demografi Pasien.................................................................................61
5.1.1 Jenis Kelamin....................................................................................61
5.1.2 Usia...................................................................................................62
5.1.3 Status Pasien.....................................................................................62
5.2 Distribusi diagnosa penyerta gagal jantung..................................................63
5.3 Manajemen terapi pasien gagal jantung.......................................................63
5.3.1 Penggunaan kombinasi digoxin dan furosemid................................63
5.3.2 Pola kombinasi digoxin dan furosemid.............................................63
5.3.3 Pergantian dosis/frekuensi/rute digoxin dan furosemid....................65
5.3.4 Lama terapi kombinasi digoxin dan furosemid................................66
5.4 Monitoring elektrolit....................................................................................66
5.5 Terapi lain yang diberikan pada pasien gagal jantung.................................67
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5.6 Lama masuk rumah sakit (MRS)..................................................................68
5.7 Kondisi Keluar Rumah sakit.........................................................................68
BAB VI PEMBAHASAN......................................................................................70
BAB VII KESIMPULAN DAN SARAN..............................................................84
7.1 Kesimpulan...................................................................................................84
7.2 Saran.............................................................................................................84
DAFTAR PUSTAKA ........................................................................................... 85
xv
DAFTAR TABEL
Halaman
Tabel 2.1 Etiologi Gagal Jantung (Dipiro, 2015) .................................................... 8
Tabel 2.2 Klasifikasi Gagal Jantung Menurut NYHA (Ponikowsky, 2016)..........11
Tabel 2.3 Tingkatan Gagal Jantung Menurut ACC/AHA (AHA, 2013)...............12
Tabel 2.4 Faktor Risiko Gagal Jantung (Mcmurray et al., 2012) ......................... 14
Tabel 2.5 Dosis Diuretik Yang Biasa Digunakan Oleh Pasien Gagal Jantung .... 30
Tabel 2.6 Perbandingan Farmakologi Diuretik Loop (Brater, 2011) .................... 32
Tabel 2.7 Sediaan Furosemid Di Indonesia (MIMS Indonesia, 2016 Dan ISO
Indonesia, 2014) .................................................................................................... 35
Tabel 2.8 Sediaan Digoxin Di Indonesia (MIMS Indonesia, 2017 Dan ISO
Indonesia, 2014). ................................................................................................... 47
Tabel 2.9 Dosis Antagonis Aldosteron (Lidenfeld et al., 2010) ........................... 50
Tabel 2.10 Dosis ACEI Pada Gagal Jantung (Aldredge et al., 2013). .................. 51
Tabel 2.11 Dosis Angiotensin Receptor Blocker (ARB) (Mpe et al., 2013). ....... 52
Tabel 3.1 Skema Kerangka Konseptual.................................................................54
Tabel 3.2 Skema Kerangka Operasional................................................................55
Tabel V.1 Distribusi Jenis Kelamin.......................................................................61
Tabel V.2 Usia Pasien............................................................................................62
Tabel V.3 Distribusi Status Pasien Gagal Jantung.................................................62
Tabel V.4 Diagnosa Penyerta Gagal Jantung.........................................................63
Tabel V.5 Penggunaan Kombinasi Digoxin Dan Furosemid Pada Pasien Gagal
Jantung...................................................................................................................63
Tabel V.6a Kombinasi 3 Obat Dengan Furosemid Rute IV..................................64
Tabel V.6b Kombinasi 3 Obat Dengan Furosemid Rute PO.................................64
Tabel V. 7 Pola Pergantian Kombinasi Digoxin Dan Furosemid..........................65
Tabel V. 8 Lama Terapi Kombinasi Digoxin Dan Furosemid...............................66
Tabel V. 9 Monitoring Serum Kalium...................................................................67
Tabel V.10 Terapi Lain Yang Diberikan Pada Pasien Gagal Jantung...................67
Tabel V.11 Lama MRS Pasien Gagal Jantung.......................................................68
Tabel V.12 Kondisi KRS.......................................................................................68
xvi
DAFTAR GAMBAR
Halaman
gambar 2.1 Struktur Jantung (NIH, 2011) .............................................................. 6
Gambar 2.2 Jantung Normal (Kiri) Dan Gagal Jantung (Kanan) (Anonim, 2014)..7
Gambar 2.3 Patofisiologi Gagal Jantung .............................................................. 18
Gambar 2.4 Mekanisme Kompensasi Gagal Jantung (G. Jackson, et al., 2000)... 18
Gambar 2.5 Fisiologis Sistem Renin Angiotensin-Aldosteron (Neal MJ, 2005) .. 20
Gambar 2.6 Ilustrasi Hipertrofi Ventrikel Kiri (Anonim, 2017) ........................... 21
Gambar 2.7 Manifestasi Klinis Gagal Jantung (Anonim, 2017). .......................... 23
Gambar 2.8 Algoritma Diagnostik Gagal Jantung (Siswanto et al., 2015)............24
Gambar 2.9 Penatalaksanaan Gagal Jantung (Yancy, et al., 2013). ..................... 27
Gambar 2.10 Skema Representasi Dari Kerja Obat Pada Gagal Jantung (Walker,
R., 2012) ................................................................................................................ 29
Gambar 2.11 Terapi Diuretik (Ter Maaten, J. M. Et al..2015) ............................. 30
Gambar 2.12 Struktur Kimia Furosemid (C12H11ClN2O5S) (Anonim, 2017) ....... 31
Gambar 2.13 Mekanisme Kerja Diuretik Tiazid (Anonim, 2017) ........................ 39
Gambar 2.14 Mekanisme Kerja Obat Inotropik Di Kardiomiosit (Francis, G. S., et
al., 2014) ............................................................................................................... 41
Gambar 2.15 Struktur Kimia Digoxin C41H64O14 (FI V, 2014). ........................... 42
Gambar 2.16 Mekanisme Kerja Digoxin (Anonim, 2017). .................................. 43
Gambar 2.17 Mekanisme Angiotensin Receptor Blocker (ARB) (Aldredge et al.,
2013). .................................................................................................................... 52
Gambar 3.18 Skema Kerangka Konseptual...........................................................55
Gambar 3.18 Skema Kerangka Operasional..........................................................56
Gambar 5.1 Skema Kriteria Inklusi Dan Eksklusi Penelitian Pada Pasien Gagal
Jantung...................................................................................................................61
Gambar 5.2 Diagram Kondisi KRS Pasien Gagal Jantung....................................69
xvii
DAFTAR LAMPIRAN
Halaman
Lampiran 1. Daftar Riwayat Hidup ....................................................................... 92
Lampiran 2. Surat pernyataan ............................................................................... 93
Lampiran 3. Surat Keputusan Dekan .................................................................... 94
Lampiran 4. Surat ijin penelitian (Bankesbanpol) ................................................ 95
Lampiran 5. Surat ijin penelitian (RSUD Kabupaten Kediri) ............................... 96
Lampiran 6. Surat Keterangan Selesai Penelitian ................................................. 97
Lampiran 7. Kode Etik Penelitian..........................................................................99
Lampiran 8. Daftar Nilai normal..........................................................................100
Lampiran 9. Lembar Pengumpul Data.................................................................101
Lampiran 10. Tabel induk....................................................................................186
xviii
DAFTAR SINGKATAN
ACE: Angiotensin Converting Enzym
ADHERE: Acute Decompensated Heart Failure National Registry
ADHF: Acute Decompensated Heart Failure
AHA: American Heart Association
ANP: Atrial Natriuretic Peptide
ATPase: Adenosine Trifosfatase
BNP: B-type Natriuretic Peptide
CBP: Cardiopulmonary Bypass
CCB: Calsium Canal Blocker
CK MB: Creatinin Kinase M-B
CK: Creatinine Kinase
EKG: Elektrokardiogram
GFR: Glomerulus Filtration Rate
HDL: High Density Lipoprotein
HF: Heart Failure
IM: Infark Miokard
KRS: Keluar Rumah Sakit
LDL: Low Density Lipoprotein
LPD: Lembar Pengumpul Data
LVEF: Left Vantricular Ejection Fraction
LVEF: Left Vantricular Ejection Fraction
MRI: Magnetic Resonance Imaging
xix
MRS: Masuk Rumah Sakit
NSAID: Non-Steroid Anti Inflamatory Drug
NYHA: New York Heart Association
PND: Dyspneu Nokturnal Paroksimalis
RAAS: Renin Angiotensin-Aldosterone System
RALES: Randomized Aldactone Evaluation Study
RMK: Rekam Medik Kesehatan
USG: Ultrasonography
85
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