Kesimpulan Saran KESIMPULAN DAN SARAN

BAB 6 KESIMPULAN DAN SARAN

6.1. Kesimpulan

Berdasarkan hasil dan pembahasan dalam penelitian, maka dapat diambil kesimpulan sebagai berikut : 1. Penggunaan obat antagonis neurohormonal ACE-iARB, Beta-blocker, dan MRA dalam penatalaksanaan gagal jantung kronis di RSUP H. Adam Malik masih perlu ditingkatkan. 2. Penggunaan obat simptomatik diuretik sudah cukup baik, tetapi penggunaan digitalis masih sedikit. 3. Berdasarkan GAI-3, kategori terbanyak adalah moderate. 4. Berdasarkan GAI-5, kategori terbanyak adalah moderate. 5. Terdapat hubungan yang bermakna antara komorbid hipertensi dan penerapan pedoman tata laksana berdasarkan GAI-3. 6. Terdapat hubungan yang bermakna antara umur dan penerapan pedoman tata laksana berdasarkan GAI-5. 7. Terdapat hubungan antara etiologi kardiomiopati dan penerapan pedoman tata laksana berdasarkan GAI-5.

6.2. Saran

Beberapa hal yang dapat sarankan penulis berdasarkan penelitian yang telah dilakukan, yaitu : 1. Diharapkan untuk penelitian selanjutnya dapat dilakukan dalam skala yang yang lebih luas. 2. Penelitian selanjutnya juga diharapkan dapat dilakukan dengan data primer dan sekaligus dapat dilakukan follow-up. 3. Penelitian selanjutnya juga diharapkan dapat menggunakan desain penelitian analitik, sehingga dapat menilai bagaimana outcome dari penatalaksanaan yang telah dilakukan. Universitas Sumatera Utara 4. Perlu juga dilakukan penelitian lebih lanjutterhadap sikap dokter dalam penerapan pedoman tata laksana gagal jantung. Universitas Sumatera Utara DAFTAR PUSTAKA Abraham, W.T. dan Hasan, A., 2007. Diagnosis and Management of Heart Failure. Dalam: R.A. Walsh, D.I. Simon, B.D. Hoit, J.C. Fang dan M. Costa, eds. 2007.Hurst’s The Heart. Edisi ke-12. USA: McGraw-Hill. Bab 26. Ajuluchukwu, J.N., Anyika, E.N. dan Raji, K.A., 2014. Physician-adherence to pharmacotherapy guidelines for chronic heart failure in a tertiary health facility in Lagos, Nigeria. Journal of Hospital Administration 32: 32-41. Aleksova, A., Masson, S., Maggioni, A.P., Lucci, D., Urso, R., Staszewsky, L., Ciaffoni, S., Cacciatore, G., Misuraca, G., Gulizia, M., Mos, L., Proietti, G., Minneci, C., Latini, R. dan Sinagra, G., 2012. Effects of Candesartan on Left Ventricular Function, Aldosterone and BNP in Chronic Heart Failure. Cardiovascular Drugs and Therapy 26 :131–143. Badan Penelitian dan Pengembangan Kesehatan. 2013. Riset Kesehatan Dasar. Kementerian kesehatan RI. Jakarta. Badan Perencanaan Pembangunan Nasional. 2013. Proyeksi Penduduk Indonesia: 2010-2035. Badan Pusat Statistik. Jakarta. Bleumink, G.S., Knetsch, A.M., Sturkenboom, M.C.J.M., Straus, S.M.J.M., Hofman, A., Deckers, J.W., Witteman, J.C.M. dan Stricker, B.H.Ch., 2004. Quantifying the Heart Failure Epidemic: Prevalence, Incidence Rate, Lifetime Risk and Prognosis of Heart Failure. European Heart Journal 25: 1614–1619. Bower, K.M., 2003. When To Use Fisher’s Exact Test. Six Sigma Forum Magazine 24: 35-37. Braun, E., Landsman, K., Zuckerman, R., Berger, G., Meilik, A. dan Azzam, Z.S., 2009. Adherence to Guidelines Improves the Clinical Outcome of Patients Universitas Sumatera Utara with Acutely Decompensated Heart Failure. Israel Medical Association Journal 11: 348-353. Brouwers, F.P., de Boer, R.A., van der Harst, P., Voors, A.A., Gansevoort, R.T., Bakker, S.J., Hillege, H.L., van Veldhuisen, D.J. dan van Gilst, W.H., 2013. Incidence and epidemiology of new onset heart failure with preserved vs.reduced ejection fraction in a community-based cohort: 11-year follow- up of PREVEND. European Heart Journal 34: 1424–1431. Calvert, M.J., Shankar, A., McManus, R.J., Ryan, R. dan Freemantle, N., 2009. Evaluation of the management of heart failure in primary care. Family Practice 26: 145-153. Chatterjee, N.A. dan Fifer, M.A., 2011. Heart Failure. Dalam: L.S. Lilly, ed. 2011. Pathophysiology of Heart Disease. Edisi ke-5. Philadelphia: Lippincott Williams Wilkins. Bab 9. Cowie, M.R., Wood, D.A., Coats, A.J.S., Thompson, S.G., Poole-Wilson, P.A., Suresh, V. dan Sutton, G.C., 1999. Incidence and aetiology of heart failure. European Heart Journal 20: 421-428. Davies, M.K., Hobbs, F.D.R., Davis, R.C., Kenkre, J.E., Roalfe, A.K., Hare, R., Wosornu, D. dan Lancashire, R.J., 2001. Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study. The Lancet 358: 439- 444. Engelhardt, S., 2005. β-Adrenergic Signaling in Heart Failure. Dalam: G.W. Dec, T. DiSalvo, R.J. Hajjar dan M.J. Semigran, eds. 2005. HEART FAILURE: A Comprehensive Guide to Diagnosis and Treatment . New York: Marcel Dekker. Bab 5. Erhardt, L., Komajda, M., Hobbs, F.D.R. dan Soler-Soler, J., 2008. Cardiologists awareness and perceptions of guidelines for chronic heart failure: The Universitas Sumatera Utara ADDress your Heart survey. European Journal of Heart Failure 10: 1020– 1025. Frankenstein, L., Remppis, A., Fluegel, A., Doesch, A., Katus, H.A., Senges, J. dan Zugck, C., 2010. The association between long-term longitudinal trends in guideline adherence and mortality in relation to age and sex. European Journal of Heart Failure 12: 574-580. Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., Borden, W.B., Bravata, D.M., Dai, S., Ford, E.S., Fox, C.S., Franco, S., Fullerton, H.J., Gillespie, C., Hailpern, S.M., Heit, J.A., Howard, V.J., Huffman, M.D., Kissela, B.M., Kittner, S.J., Lackland, D.T., Lichtman, J.H., Lisabeth, L.D., Magid, D., Marcus, G.M., Marelli, A., Matchar, D.B., McGuire, D.K., Mohler, E.R., Moy, C.S., Mussolino, M.E., Nichol, G., Paynter, N.P., Schreiner, P.J., Sorlie, P.D., Stein, J., Turan, T.N., Virani, S.S., Wong, N.D., Woo, D. danTurner, M.B., 2013. Heart Disease and Stroke Statistics - 2013 Update: A Report From the American Heart Association. Circulation 127: e6-e245. Ives, H.E., 2007. Obat Diuretik. Dalam: B.G. Katzung, ed. 2007. Farmakologi Dasar Klinik . Edisi ke-10. Diterjemahkan oleh A.W. Nugroho, L. Rendy dan L. Dwijayanthi. Jakarta: Penerbit Buku Kedokteran EGC. Bab 15. Kelder, J.C., Cramer, M.J., Wijngaarden, J., Tooren, R., Mosterd, A., Moons, K.G.M., Lammers, J.W., Cowie, M.R., Grobbee, D.E. dan Hoes, A.W., 2011. The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure. Circulation 124: 2865-2873. Komajda, M.,Follath, F., Swedberg, K., Cleland, J., Aguilar, J.C., Cohen-Solal, A., Dietz, R., Gavazzi, A., Van Gilst, W.H., Hobbs, R., Korewicki, J., Madeira, H.C., Moiseyev, V.S., Preda, I., Widimsky, J., Freemantle, N., Eastaugh, J. dan Mason, J., 2003. The EuroHeart Failure Survey Universitas Sumatera Utara programme—a survey on the quality of care among patients with heart failure in Europe: Part 2:treatment. European Heart Journal 24: 464-474. Komajda, M., Lapuerta, P., Hermans, N., Gonzalez-Juanatey, J.R., van Veldhuisen, D.J., Erdmann, E.,Tavazzi, L., Poole-Wilson, P. dan Le Pen, C., 2005. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. European Heart Journal 26: 1653-1659. Lόpez-Sendόn, J., Swedberg, K., McMurray, J., Tamargo, J., Maggioni A.P., Dargie, H., Tendera, M., Waagstein F., Kjekshus, J., Lechat, P., Torp- Pedersen, C., Priori, S.G., García, M.A.A., Blanc, J-J., Budaj, A., Cowie, M., Dean, V., Deckers, J., Burgos, E.F., Lekakis, J., Lindahl, B., Mazzotta, G., McGregor, K., Morais, J., Oto, A., Smiseth, O.A., Ardissino, D., Avendano, C., Blomström-Lundqvist, C., Clément, D., Drexler, H., Ferrari, R., Fox, K.A., Julian, D., Kearney,P., Klein, W., Köber, L., Mancia, G., Nieminen, M., Ruzyllo, W., Simoons, M., Thygesen, K., Tognoni, G., Tritto, I., Wallentin, L., 2004. Expert consensus document on β-adrenergic receptor blockers: The Task Force on Beta-Blockers of the European Society of Cardiology. European Heart Journal 25: 1341-1362. Madiyono, B. et al., 2011. Perkiraan besar sampel. Dalam: S. Sastroasmoro dan I. Sofyan, eds. 2011. Dasar-dasar Metodologi Penelitian Klinis. Edisi ke-4. Jakarta: Sagung Seto. Bab 17. Maggioni, A.P., Anker, S.D., Dahlström, U., Filippatos, G., Ponikowski, P., Zannad, F., Amir, O., Chioncel, O., Leiro, M.C., Drozdz, J., Erglis, A., Fazlibegovic, E., Fonseca, C., Fruhwald, F., Gatzov, P., Goncalvesova, E., Hassanein, M., Hradec, J., Kavoliuniene, A., Lainscak, M., Logeart, D., Merkely, B., Metra, M., Persson, H., Seferovic, P., Temizhan, A., Tousoulis, D. dan Tavazzi, L., 2013. Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines?Evidence from 12.440 patients of the ESC Heart Failure Long- Term Registry. European Journal of Heart Failure 15: 1173-1184. Universitas Sumatera Utara Maggioni, A.P., Dahlström, U., Filippatos, G., Chioncel, O., Leiro, M.C., Drozdz, J., Fruhwald, F., Gullestad, L., Logeart, D., Metra, M., Parissis, J., Persson, H.,Ponikowski, P., Rauchhaus, M., Voors, A., Nielsen, O.W., Zannad, F. dan Tavazzi, L., 2010. EURObservational Research Programme: The Heart Failure Pilot Survey ESC-HF Pilot.European Journal of Heart Failure 12: 1076-1084. Maggioni, A.P., Dahlström, U., Filippatos, G., Chioncel, O., Leiro, M.C., Drozdz, J., Fruhwald, F., Gullestad, L., Logeart, D., Fabbri, G., Urso, R., Metra, M., Parissis, J., Persson, H., Ponikowski, P., Rauchhaus, M., Voors, A.A., Nielsen, O.W., Zannad, F. dan Tavazzi, L., 2013. EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey ESC-HF Pilot. European Journal of Heart Failure 15: 808-817. Mancia, G., Fagard, R., Narkiewicz, K., Redόn, J., Zanchetti, A., B ö hm, M., Christiaens, T., Cifkova, R., Backer, G.D., Dominiczak, A., Galderisi, M., Grobbee, D.E., Jaarsma, T., Kirchhof, P., Kjeldsen, S.E., Laurent, S., Manolis, A.J., Nilsson, P.M., Ruilope, L.M., Schmieder, R.E., Sirnes, P.A., Sleight, P., Viigimaa, M., Waeber, B. dan Zannad, F., 2013. 2013 ESHESC Guidelines for themanagement of arterial hypertension: TheTask Force for the management ofarterial hypertension of the European Society of Hypertension ESH and of the European Society of Cardiology ESC. Journal of Hypertension 317:1281-1357. Manikandan, S., 2011. Measures of central tendency: Median and mode. Journal of Pharmacology and Pharmacotherapeutics 23: 214-215. Mann, D.L., 2012. Pathophysiology of Heart Failure. Dalam: R.O. Bonow, D.L. Mann, D.P. Zipes dan P. Libby, eds. 2012. Braunwalds Heart Disease: A Textbook of Cardiovascular Medicine. Edisi ke-9. Philadelphia: Saunders. Bab 25. Universitas Sumatera Utara Mann, D.L., 2012. Management of Heart Failure Patients with Reduced Ejection Fraction. Dalam: R.O. Bonow, D.L. Mann, D.P. Zipes dan P. Libby, eds. 2012. Braunwalds Heart Disease: A Textbook of Cardiovascular Medicine. Edisi ke-9. Philadelphia: Saunders. Bab 28. Mant, J., Doust, J., Roalfe, A., Barton, P., Cowie, M.R., Glasziou, P., Mant, D., McManus, R.J., Holder, R., Deeks, J., Fletcher, K., Qume, M., Sohanpal, S., Sanders, S. dan Hobbs, F.D.R., 2009. Systematic review and individual patient data meta-analysis of diagnosis of heart failure, with modelling of implications of different diagnostic strategies in primary care. Health Technology Assessment 1332: 1-207. McMullen, J.R. dan Jennings, G.L., 2007. Differences Between Pathological and Physiological Cardiac Hypertrophy: Novel Therapeutic Strategies to Treat Heart Failure. Clinical and Experimental Pharmacology and Physiology 34: 255–262. McMurray, J.J.V., Adamopoulos, S., Anker, S.D., Auricchio, A., Böhm, M., Dickstein, K., Falk, V., Filippatos, G., Fonseca, C., Gomez-Sanchez, M.A.,Jaarsma, T., Køber, L., Lip, G.Y.H., Maggioni, A.P., Parkhomenko, A., Pieske, B.M., Popescu, B.A., Rønnevik, P.K., Rutten, F.H., Schwitter, J., Seferovic, P., Stepinska, J., Trindade, P.T., Voors, A.A., Zannad, F., Zeiher, A., Bax, J.J., Baumgartner, H., Ceconi, C., Dean, V., Deaton, C., Fagard, R., Funck-Brentano, C., Hasdai, D., Hoes, A., Kirchhof, P., Knuuti, J., Kolh, P., McDonagh, T., Moulin, C., Reiner, Ž., Sechtem, U., Sirnes, P.A., Tendera, M., Torbicki, A., Vahanian, A., Windecker, S., Bonet, L.A., Avraamides, P., Ben Lamin, H.A., Brignole, M., Coca, A., Cowburn, P., Dargie, H., Elliott, P., Flachskampf, F.A., Guida, G.F., Hardman, S., Iung, B., Merkely, B., Mueller, C., Nanas, J.N., Nielsen, O.W., Ørn, S., Parissis, J.T. dan Ponikowski, P., 2012. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society Universitas Sumatera Utara of Cardiology. Developed in collaboration with the Heart Failure Association HFA of the ESC. European Heart Journal 33: 1787-1847. Mosterd, A., Hoes, A.W., de Bruyne, M.C., Deckers, J.W., Linker, D.T., Hofman, A. dan Grobbee, D.E., 1999. Prevalence of heart failure and left ventricular dysfunction in the general population. European Heart Journal 20: 447-455. Mosterd, A. dan Hoes, A.W., 2007. Clinical Epidemiology of Heart Failure. Heart 93:1137–1146. Nafrialdi, 2009. Antihipertensi. Dalam: S.G. Gunawan, R.S. Nafrialdi dan Elysabeth, eds. 2009. Farmakologi dan Terapi. Edisi ke-5. Jakarta: Balai Penerbit FKUI. Halaman: 341-360. Notoatmodjo, S., 2012. Metodologi penelitian kesehatan. Edisi revisi.Jakarta: Rineka Cipta. Oudejans, I., 2012. Heart failure in geriatric outpatients: diagnosis, prognosis and treatment . Disertasi. Universitas Utrecht. Oudejans, I., Mosterd, A., Bloemen, J.A., Valk, M.J., Velzen, E., Wielders, J.P., Zuithoff, N.P., Rutten, F.H. dan Hoes, A.W., 2011. Clinical evaluation of geriatric outpatients with suspected heart failure: value of symptoms, signs, and additional tests. European Journal of Heart Failure 13: 518-527. Peters-Klimm, F., Müller-Tasch, T., Schellberg, D., Remppis, A., Barth, A., Holzapfel, N., Jünger, J., Herzog, W. dan Szecsenyi, J., 2008. Guideline adherence for pharmacotherapy of chronic systolic heart failure in general practice: a closer look on evidence-based therapy. Clinical Research in Cardiology 97: 244-252. Reibis, R., Dovifat, C., Dissmann, R., Ehrlich, B., Schulz, S., Stolze, K., Wegscheider, K. dan Völler, H., 2006. Implementation of evidence- Universitas Sumatera Utara basedtherapy in patients with systolic heart failure from 1998–2000. Clinical Research in Cardiology 95: 154-161. Richardson, D.M., Bain, K.T., Diamond, J.J., Novielli, K.D., Lee, S.P. dan Goldfarb, N.I., 2010. Effectiveness of Guideline-Recommended Cardiac Drugs for Reducing Mortality in the Elderly Medicare Heart Failure Population: A Retrospective, Survey-Weighted, Cohort Analysis. Drugs Aging 2710: 845-854. Sastroasmoro, S., 2011. Pemilihan subyek penelitian. Dalam: S. Sastroasmoro dan I. Sofyan, eds. 2011. Dasar-dasar Metodologi Penelitian Klinis. Edisi ke-4. Jakarta: Sagung Seto. Bab 5. Setiawati, A. dan Nafrialdi, 2009. Obat Gagal Jantung. Dalam: S.G. Gunawan, R.S. Nafrialdi dan Elysabeth, eds. 2009. Farmakologi dan Terapi. Edisi ke-5. Jakarta: Balai Penerbit FKUI. Halaman: 299-313. Shoukat, S., Gowani, S.A., Taqui, A.M., Hassan R.U., Bhutta, Z.A., Malik, A.L., Sherjeel, S.A., Sheheryar, Q. dan Dhakam, S.H., 2011. Adherence to the European Society of Cardiology ESC guidelines for chronic heart failure - A national survey of the cardiologists in Pakistan. BMC Cardiovascular Disorders 1168: 1-8. Stewart, S., MacIntyre, K., Hole, D.J., Capewell, S. dan McMurray, J.J.V., 2001. More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure. European Journal of Heart Failure 3: 315-322. Störk, S., Hense, H.W., Zentgraf, C., Uebelacker, I., Jahns, R., Ertl, G. dan Angermann, C.E., 2008. Pharmacotherapy according to treatment guidelines is associated with lower mortality in a community-based sample of patients with chronic heart failure: A prospective cohort study. European Journal of Heart Failure 10: 1236-1245. Universitas Sumatera Utara Sumartono, W., Sirait, A.M., Holy, M. dan Thabrany, H., 2011. Smoking and Socio-Demographic Determinant of Cardiovascular Diseases among Males 45+ Years in Indonesia. International Journal of Environmental Research and Public Health 8: 528-539. Triposkiadis, F., Karayannis, G., Giamouzis, G., Skoularigis, J., Louridas, G. dan Butler, J., 2009. The Sympathetic Nervous System in Heart Failure: Physiology, Pathophysiology, and Clinical Implications. Journal of the American College of Cardiology 5419: 1747–1762. van Berlo, J.H., Maillet, M. dan Molkentin, J.D., 2013. Signaling effectors underlying pathologic growth and remodeling of the heart. Journal of Clinical Investigation 1231: 37-45. Wahyuni, A.S., 2007. Statistika Kedokteran. Edisi ke-1. Jakarta Timur: Bamboedoea Communication. Yamin, C.K., Miller, C.A., Antman, E.M., Strichartz, G.R. dan Lilly, L.S., 2011. Cardiovascular Drugs. Dalam: L.S. Lilly, ed. 2011. Pathophysiology of Heart Disease . Edisi ke-5. Philadelphia: Lippincott Williams Wilkins. Bab 17. 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Universitas Sumatera Utara LAMPIRAN 1 DAFTAR RIWAYAT HIDUP Nama Lengkap : Khalis Hamdani Nama Panggilan : Khalis Tempat, Tanggal Lahir : Banda Aceh, 02 Juni 1992 Agama : Islam Jenis Kelamin : Pria Nama Orangtua : Ayah : Hamdani Oesman Ibu : Falmuriati Anak Ke- : 2 dari 4 bersaudara Alamat : Komplek Bumi Asri No.105 Blok-D, Medan, 20126 Telepon : 081360985533 Email : khalis_02yahoo.com Hobby : Musik, Olahraga Riwayat Pendidikan :  SD Negeri 5 Lhokseumawe 1998 – 2004  SMP Negeri 1 Lhokseumawe 2004 – 2007  SMA Fatih Bilingual School Banda Aceh 2007 – 2010  Fakultas Kedokteran Universitas Sumatera Utara 2011 – Sekarang Universitas Sumatera Utara Pengalaman Organisasi :  Anggota Divisi Pengembangan Potensi Ilmiah SCORE-PEMA FK USU  Anggota Divisi Project Officer of Office SCORE-PEMA FK USU  Anggota Divisi Kreativitas dan Kemahasiswaan Panitia Hari Besar Islam Fakultas Kedokteran Universitas Sumatera Utara Universitas Sumatera Utara LAMPIRAN 2 DATA INDUK PENELITIAN Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara Universitas Sumatera Utara LAMPIRAN 3 HASIL OUTPUT ANALISIS UNIVARIAT 1. Umur Statistic Std. Error Umur Mean 55.64 1.195 95 Confidence Interval for Mean Lower Bound 53.27 Upper Bound 58.01 5 Trimmed Mean 55.97 Median 57.00 Variance 138.421 Std. Deviation 11.765 Minimum 19 Maximum 80 Range 61 Interquartile Range 16 Skewness -.465 .245 Kurtosis .341 .485 Tests of Normality Kolmogorov-Smirnov a Shapiro-Wilk Statistic df Sig. Statistic df Sig. Umur .087 97 .069 .981 97 .170 a. Lilliefors Significance Correction Kelompok Umur Frequency Percent Valid Percent Cumulative Percent Valid 19-28 2 2.1 2.1 2.1 29-38 5 5.2 5.2 7.2 39-48 19 19.6 19.6 26.8 49-58 25 25.8 25.8 52.6 59-68 33 34.0 34.0 86.6 69-78 11 11.3 11.3 97.9 79+ 2 2.1 2.1 100.0 Total 97 100.0 100.0 Universitas Sumatera Utara

2. Jenis Kelamin

Frequency Percent Valid Percent Cumulative Percent Valid Laki-laki 78 80.4 80.4 80.4 Perempuan 19 19.6 19.6 100.0 Total 97 100.0 100.0

3. Denyut Jantung

Statistic Std. Error Denyut Jantung Mean 86.28 2.012 95 Confidence Interval for Mean Lower Bound 82.29 Upper Bound 90.27 5 Trimmed Mean 84.44 Median 84.00 Variance 392.557 Std. Deviation 19.813 Minimum 59 Maximum 162 Range 103 Interquartile Range 26 Skewness 1.402 .245 Kurtosis 2.996 .485 Tests of Normality Kolmogorov-Smirnov a Shapiro-Wilk Statistic Df Sig. Statistic df Sig. Denyut Jantung .121 97 .001 .894 97 .000 a. Lilliefors Significance Correction

4. Tekanan Darah Sistolik

Statistic Std. Error Sistol Mean 124.42 2.376 95 Confidence Interval for Mean Lower Bound 119.71 Upper Bound 129.14 5 Trimmed Mean 122.94 Median 120.00 Variance 547.434 Std. Deviation 23.397 Universitas Sumatera Utara Minimum 90 Maximum 220 Range 130 Interquartile Range 25 Skewness 1.182 .245 Kurtosis 2.133 .485 Tests of Normality Kolmogorov-Smirnov a Shapiro-Wilk Statistic Df Sig. Statistic df Sig. Sistol .142 97 .000 .920 97 .000 a. Lilliefors Significance Correction Kategori Tekanan Sistolik Frequency Percent Valid Percent Cumulative Percent Valid Grade 1 12 12.4 12.4 12.4 Grade 2 6 6.2 6.2 18.6 Grade 3 2 2.1 2.1 20.6 Hi Normal 15 15.5 15.5 36.1 Normal 23 23.7 23.7 59.8 Optimal 39 40.2 40.2 100.0 Total 97 100.0 100.0

5. Tekanan Darah Diastolik

Statistic Std. Error Diastol Mean 80.22 1.682 95 Confidence Interval for Mean Lower Bound 76.88 Upper Bound 83.56 5 Trimmed Mean 79.26 Median 80.00 Variance 274.463 Std. Deviation 16.567 Minimum 50 Maximum 147 Range 97 Interquartile Range 21 Skewness 1.128 .245 Universitas Sumatera Utara Kurtosis 2.657 .485 Tests of Normality Kolmogorov-Smirnov a Shapiro-Wilk Statistic Df Sig. Statistic df Sig. Diastol .155 97 .000 .929 97 .000 a. Lilliefors Significance Correction Kategori Tekanan Diastolik Frequency Percent Valid Percent Cumulative Percent Valid Grade 1 12 12.4 12.4 12.4 Grade 2 10 10.3 10.3 22.7 Grade 3 4 4.1 4.1 26.8 Hi Normal 2 2.1 2.1 28.9 Normal 27 27.8 27.8 56.7 Optimal 42 43.3 43.3 100.0 Total 97 100.0 100.0

6. Etiologi

Responses Percent of Cases N Percent Etiologi a CAD 65 48.1 67.0 HHD 46 34.1 47.4 Kelainan katup 15 11.1 15.5 Kardiomiopati 7 5.2 7.2 CHD 2 1.5 2.1 Total 135 100.0 139.2

7. Komorbid

Responses Percent of Cases N Percent komorbid Atrial Fibrilasi 19 15.6 19.6 Hipertensi 20 16.4 20.6 Supraventrikular takikardia 1 0.8 1.0 Riwayat Stroke 3 2.5 3.1 Efusi Perikard 3 2.5 3.1 LV Trombus 2 1.6 2.1 PPOK 5 4.1 5.2 Universitas Sumatera Utara ISPA 9 7.4 9.3 DM type 2 10 8.2 10.3 Urolithiasis 2 1.6 2.1 BPH 1 0.8 1.0 Hipertiroid 1 0.8 1.0 AKICKD 5 4.1 5.2 Congestive Hepatopathy 1 0.8 1.0 Spondilolistesis Lumbalis 1 0.8 1.0 Dispepsia 1 0.8 1.0 Tidak 38 31.1 39.2 Total 122 100.0 125.8

8. Gejala dan Tanda

Responses Percent of Cases N Percent Gejala Tanda DOE 87 40.5 89.7 PND 31 14.4 32.0 OP 20 9.3 20.6 Edema Pretibial 18 8.4 18.6 TVJ 11 5.1 11.3 Ronki Basah 20 9.3 20.6 Palpitasi 6 2.8 6.2 Tidak 3 1.4 3.1 Total 215 100.0 221.6

9. Gambaran Ekokardiografi

Statistic Std. Error Fraksi Ejeksi Mean 32.7677 .62134 95 Confidence Interval for Mean Lower Bound 31.5344 Upper Bound 34.0011 5 Trimmed Mean 33.1293 Median 34.0000 Variance 37.448 Std. Deviation 6.11948 Minimum 14.80 Maximum 40.00 Universitas Sumatera Utara Range 25.20 Interquartile Range 8.96 Skewness -.751 .245 Kurtosis -.314 .485 Tests of Normality Kolmogorov-Smirnov a Shapiro-Wilk Statistic Df Sig. Statistic df Sig. Fraksi Ejeksi .134 97 .000 .916 97 .000 a. Lilliefors Significance Correction 10. Tata Laksana 10.1 Gagal Jantung ACE-i Frequency Percent Valid Percent Cumulative Percent Valid Captopril 57 58.8 58.8 58.8 Ramipril 6 6.2 6.2 64.9 Lisinopril 2 2.1 2.1 67.0 Tidak 32 33.0 33.0 100.0 Total 97 100.0 100.0 ARB Frequency Percent Valid Percent Cumulative Percent Valid Candesartan 8 8.2 8.2 8.2 Valsartan 3 3.1 3.1 11.3 Tidak 86 88.7 88.7 100.0 Total 97 100.0 100.0 Beta-blocker Frequency Percent Valid Percent Cumulative Percent Valid Bisoprolol 60 61.9 61.9 61.9 Tidak 37 38.1 38.1 100.0 Total 97 100.0 100.0 MRA Frequency Percent Valid Percent Cumulative Percent Valid Spironolakton 60 61.9 61.9 61.9 Universitas Sumatera Utara Tidak 37 38.1 38.1 100.0 Total 97 100.0 100.0 Diuretik Frequency Percent Valid Percent Cumulative Percent Valid Furosemid 87 89.7 89.7 89.7 Tidak 10 10.3 10.3 100.0 Total 97 100.0 100.0 Digitalis Frequency Percent Valid Percent Cumulative Percent Valid Digoxin 26 26.8 26.8 26.8 Tidak 71 73.2 73.2 100.0 Total 97 100.0 100.0 Kategori GAI-3 Frequency Percent Valid Percent Cumulative Percent Valid Low 25 25.8 25.8 25.8 Moderate 44 45.4 45.4 71.1 High 28 28.9 28.9 100.0 Total 97 100.0 100.0 Kategori GAI-5 Frequency Percent Valid Percent Cumulative Percent Valid Low 3 3.1 3.1 3.1 Moderate 58 59.8 59.8 62.9 High 36 37.1 37.1 100.0 Total 97 100.0 100.0 GAI-3 GAI-5 N Valid 97 97 Missing Mean .6742 .6392 Median .6700 .6000 Mode .67 .60 Minimum .00 .20 Universitas Sumatera Utara Maximum 1.00 1.00 Sum 65.40 62.00 Percentiles 25 .3300 .6000 50 .6700 .6000 75 1.0000 .8000

10.2 Non-Gagal Jantung