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

xii

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

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