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"This timely book is a road map for defining the care of acute heart failure patients in the short stay or observation unit setting. Produced in collaboration with the Society of Chest Pain Centers, this book provides an understanding of the diverse medical needs and solutions, administrative processes, and regulatory issues necessary for successful management. In an environment of increasing financial consciousness, medical practice is changing drastically. Short stay care is premier among the new specialties that cater to the complex balance of optimizing patient outcomes while minimizing fiscal burdens. The observation unit has proven to be an excellent arena for the care of acute heart failure, replete with opportunities to improve both medical management and quality metrics. Unique to the field, Short stay management of acute heart failure, providing the medical, regulatory, and economic tools necessary to create and implement successful short stay management protocols and units for the care of the heart failure patient. It is an essential guide for health care professionals and for hospitals and institutions wishing to be recognized as quality heart failure centers as accredited by the Society of Chest Pain Centers."

"Latar belakang: Rehospitalisasi 30 hari pada gagal jantung menyebabkan perburukan prognosis dan paling sering terjadi karena kongesti hemodinamik yang ditandai oleh tekanan pengisian ventrikel kiri (left ventricular end diastolic pressure/LVEDP) persisten tinggi. Oleh karena itu, dekongesti komplit harus dipastikan sebelum pasien pulang dari perawatan. Salah satu modalitas yang potensial adalah skor SAFE melalui evaluasi 3 komponen kongesti hemodinamik, yaitu: pompa (ejection fraction/EF), pipa (internal jugular vein collapsibility index/IJVCI dan inferior vena cava/IVC) dan jaringan interstisial (B-lines). Pada studi ini, rerata E/e’ ditambahkan pada skor SAFE dengan pertimbangan nilai prognostik rerata E/e’ dalam memprediksi kejadian rehospitalisasi.Tujuan: Membandingkan skor SAFE dan skor SAFE+rerata E/e’ dalam memprediksi rehospitalisasi 30 hari terkait gagal jantung akut.Metode: Dilakukan studi kohort prospektif dengan melibatkan 82 orang pasien gagal jantung akut yang dirawat di RSJPDHK. Analisis bivariat dan multivariat dilakukan untuk membandingkan kemampuan prediksi skor SAFE dan skor SAFE+rerata E/e’ terhadap rehospitalisasi 30 hari terkait gagal jantung akut.Hasil: Insidensi rehospitalisasi 30 hari terkait gagal jantung akut mencapai 19,5%. Kurva Kaplan-Meier menunjukkan rehospitalisasi lebih rendah pada kondisi euvolemia daripada hipervolemia (p 0,003). Skor SAFE+rerata E/e’ memiliki kemampuan prediksi rehospitalisasi 30 hari yang lebih baik daripada skor SAFE (AUC 0,77 [95% CI: 0,64 – 0,89] vs AUC 0,74 [95% CI: 0,62 – 0,85]).Kesimpulan: Skor SAFE+rerata E/e’ memiliki kemampuan prediksi rehospitalisasi 30 hari terkait gagal jantung akut yang lebih baik daripada skor SAFE.

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Background: Short-term-rehospitalization worsens prognosis and frequently occurs due to persistently high LVEDP (hemodynamic congestion) among patients with heart failure (HF). Therefore, it is necessary to ascertain complete decongestion prior to hospital discharge. SAFE score is a potential scoring system to do so because it measures 3 main components of hemodynamic congestion: pump (EF), pipe (IJVCI and IVC) and interstitial tissue (B-lines). In this study, average E/e’ is added to SAFE score considering its clinically significant prognostic value in predicting risk of rehospitalization among patients with HF.

Aim: To compare SAFE score and SAFE score+average E/e’ in predicting 30-day-acute HF (AHF)- related-rehospitalization.

Methods: A prospective cohort study was conducted by involving 82 patients admitted with AHF in National Cardiovascular Center Harapan Kita (NCCHK). Bivariate and multivariate analysis were done to find out which of the 2 models: SAFE score and SAFE score+average E/e’ could better predict risk of 30-day-AHF-related-rehospitalization.

Results: The incidence of 30-day-AHF-related-rehospitalization in this study was 19,5%. By using Kaplan-Meier curve, we identified significantly lower 30-day-AHF-related-rehospitalization in patients discharged with euvolemia than those with hypervolemia (p 0,003). SAFE score+average E/e’ had better predictive properties than SAFE score regarding 30-day-AHF-related-rehospitalization (AUC 0,77 [95% CI: 0,64 – 0,89] vs AUC 0,74 [95% CI: 0,62 – 0,85]).

Conclusion: SAFE score+average E/e’ had better predictive properties than SAFE score regarding 30- day-AHF-related-rehospitalization."

"Latar belakang: Rehospitalisasi 30 hari pada gagal jantung menyebabkan perburukan prognosis dan paling sering terjadi karena kongesti hemodinamik yang ditandai oleh tekanan pengisian ventrikel kiri (left ventricular end diastolic pressure/LVEDP) persisten tinggi. Oleh karena itu, dekongesti komplit harus dipastikan sebelum pasien pulang dari perawatan. Salah satu modalitas yang potensial adalah skor SAFE melalui evaluasi 3 komponen kongesti hemodinamik, yaitu: pompa (ejection fraction/EF), pipa (internal jugular vein collapsibility index/IJVCI dan inferior vena cava/IVC) dan jaringan interstisial (B-lines). Pada studi ini, rerata E/e’ ditambahkan pada skor SAFE dengan pertimbangan nilai prognostik rerata E/e’ dalam memprediksi kejadian rehospitalisasi.Tujuan: Membandingkan skor SAFE dan skor SAFE+rerata E/e’ dalam memprediksi rehospitalisasi 30 hari terkait gagal jantung akut.Metode: Dilakukan studi kohort prospektif dengan melibatkan 82 orang pasien gagal jantung akut yang dirawat di RSJPDHK. Analisis bivariat dan multivariat dilakukan untuk membandingkan kemampuan prediksi skor SAFE dan skor SAFE+rerata E/e’ terhadap rehospitalisasi 30 hari terkait gagal jantung akut.Hasil: Insidensi rehospitalisasi 30 hari terkait gagal jantung akut mencapai 19,5%. Kurva Kaplan-Meier menunjukkan rehospitalisasi lebih rendah pada kondisi euvolemia daripada hipervolemia (p 0,003). Skor SAFE+rerata E/e’ memiliki kemampuan prediksi rehospitalisasi 30 hari yang lebih baik daripada skor SAFE (AUC 0,77 [95% CI: 0,64 – 0,89] vs AUC 0,74 [95% CI: 0,62 – 0,85]).Kesimpulan: Skor SAFE+rerata E/e’ memiliki kemampuan prediksi rehospitalisasi 30 hari terkait gagal jantung akut yang lebih baik daripada skor SAFE.

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Background: Short-term-rehospitalization worsens prognosis and frequently occurs due to persistently high LVEDP (hemodynamic congestion) among patients with heart failure (HF). Therefore, it is necessary to ascertain complete decongestion prior to hospital discharge. SAFE score is a potential scoring system to do so because it measures 3 main components of hemodynamic congestion: pump (EF), pipe (IJVCI and IVC) and interstitial tissue (B-lines). In this study, average E/e’ is added to SAFE score considering its clinically significant prognostic value in predicting risk of rehospitalization among patients with HF.

Aim: To compare SAFE score and SAFE score+average E/e’ in predicting 30-day-acute HF (AHF)- related-rehospitalization.

Methods: A prospective cohort study was conducted by involving 82 patients admitted with AHF in National Cardiovascular Center Harapan Kita (NCCHK). Bivariate and multivariate analysis were done to find out which of the 2 models: SAFE score and SAFE score+average E/e’ could better predict risk of 30-day-AHF-related-rehospitalization.

Results: The incidence of 30-day-AHF-related-rehospitalization in this study was 19,5%. By using Kaplan-Meier curve, we identified significantly lower 30-day-AHF-related-rehospitalization in patients discharged with euvolemia than those with hypervolemia (p 0,003). SAFE score+average E/e’ had better predictive properties than SAFE score regarding 30-day-AHF-related-rehospitalization (AUC 0,77 [95% CI: 0,64 – 0,89] vs AUC 0,74 [95% CI: 0,62 – 0,85]).

Conclusion: SAFE score+average E/e’ had better predictive properties than SAFE score regarding 30- day-AHF-related-rehospitalization."

"Latar Belakang: Beberapa penelitian telah menunjukkan bahwa hipokloremia berhubungan dengan peningkatan rehospitalisasi dan mortalitas pada pasien dengan gagal jantung (chloride hypothesis). Akan tetapi, penelitian-penelitian tersebut hanya membandingkan kelompok pasien gagal jantung dengan hipokloremia dengan kelompok normokloremia saat admisi. Tujuan: Mengetahui pengaruh normalisasi kadar klorida terhadap rehospitalisasi dan mortalitas pasien gagal jantung. Metode: Dilakukan penelitian kohort prospektif pasien gagal jantung dekompensasi akut (GJDA) yang dirawat inap dari September 2018 sampai Februari 2019. Pasien dengan hipokloremia dan normonatremia saat admisi dibagi menjadi kelompok hipokloremia persisten hingga saat pemulangan dibanding kelompok normokloremia saat pemulangan. Luaran primer adalah rehospitalisasi karena gagal jantung dalam 180 hari. Luaran sekunder adalah mortalitas dalam 180 hari. Hasil: Terdapat 162 pasien (53,6%) yang termasuk dalam kelompok hipokloremia persisten dan 140 pasien (46,3%) yang termasuk dalam kelompok normokloremia saat pemulangan. Model regresi Cox menunjukkan hipokloremia persisten tidak berkaitan bermakna dengan peningkatan rehospitalisasi karena gagal jantung (hazard ratio 1,21; interval kepercayaan 95% 0,78-1,89; p 0,392) dan mortalitas (hazard ratio 1,39; interval kepercayaan 95% 0,74-2,65; p 0,305) dibandingkan dengan kelompok normokloremia saat pemulangan. Kesimpulan: Hipokloremia persisten pada pasien GJDA bukan merupakan prediktor independen terhadap rehospitalisasi gagal jantung dan mortalitas.

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Background: Recent studies have shown that hypochloremia is associated with increased risk of rehospitalization and death in patients with heart failure (chloride hypothesis). In these studies, however, patients with hypochloremia were compared only with patients with a normal chloride level at hospital admission. Aim: To evaluate the effect of the normalization of serum chloride on the heart failure to rehospitalization and mortality. Method: This was a prospective cohort study of patients hospitalized for acute decompensated heart failure (ADHF) from September 2018 to February 2019. Patients with hypochloremia and normonatremia at admission were divided into patients with persistent hypochloremia at the time of discharge and patients who achieved normalization of their serum chloride levels at discharge. The primary outcome was 180-day rehospitalization. The secondary outcome was 180-day mortality.

Results: There were 162 patients (53,6%) with persistent hypochloremia and 140 patients (46,3%) with normochloremia at discharge. Cox regression model indicated persistent hypochloremia did not significantly predict heart failure rehospitalisation (hazard ratio 1.21; 95% confidence interval 0.78-1.89; p 0.392) and mortality (hazard ratio 1.39; 95% confidence interval 0.74-2.65; p 0.305) compared with group of normochloremia at discharge.

Conclusion: Persistent hypochloremia in ADHF patients is not an independent predictor of heart failure rehospitalisation and mortality."

"AbstrakHeart failure has become a public health problem with increasing incidence and prevalence. Many patients first came to the primary care and managed by general practitioner. Accurate diagnosis is essential to provide good management of heart failure. However, symptoms and signs alone are often neither sufficient nor specific to confirm the diagnosis. Some studies show that heart failure patients are still incorrectly diagnosed and inadequately treated, despite the availability of current guidelines. Inadequacy of facilities is the main obstacle in diagnosing and managing heart failure, especially in developing countries like Indonesia. The medications recommended for treating heart failure are still under-prescribed. This review discuss about the challenges of diagnosis and management of heart failure in primary care."

"Cardiovascular diseases (CVD) merupakan salah satu penyebab utama kematian di dunia. WHO memperkirakan angka 17,9 juta kematian pada tahun 2021 disebabkan oleh CVD. Di Indonesia sendiri, prevalensi penyakit jantung mencapai angka 1,5% atau sekitar 2,7 juta orang pada tahun 2018. CVD mencakup berbagai macam jenis penyakit jantung. Salah satu tipe penyakit jantung tersebut adalah congestive heart failure. Congestive heart failure (CHF) adalah kondisi dimana jantung tidak dapat memompa darah yang cukup ke seluruh bagian tubuh. CHF dapat terjadi dikarenakan melemahnya kemampuan otot jantung untuk memompa darah sehingga mempengaruhi heart rate atau detak jantung manusia. Heart rate dapat direpresentasikan menggunakan sinyal yang dapat diukur menggunakan alat rekaman electrocardiogram (ECG/EKG). EKG adalah rekaman aktivitas elektrik jantung yang ditangkap melalui bagian permukaan tubuh. Heart rate variability (HRV) diketahui berkorelasi dengan berbagai penyakit jantung dan salah satunya adalah CHF. Dengan berkembangnya teknologi, terdapat beberapa penelitian mengenai implementasi artificial intelligence (AI) untuk mendeteksi keberadaan CHF menggunakan model machine learning dan HRV sebagai fitur bagi model. Pada penelitian ini, akan dibangun dan dievaluasi kinerja model XGBoost untuk mendeteksi eksistensi penyakit CHF pada short-term HRV dari rekaman EKG 5 menit. Dataset yang digunakan berasal dari empat database yang berbeda yang diambil dari situs PhysioNet, yaitu NSRDB dan NSR2DB sebagai kelas sehat dan CHFDB dan CHF2DB sebagai kelas CHF. Masing-masing database memiliki rekaman long-term EKG. Seluruh rekaman tersebut dilakukan segmentasi selama 5 menit pada 2 jam pertama rekaman. Dari hasil segmentasi rekaman 5 menit tersebut akan dihitung nilai HRV yang akan menjadi fitur bagi model XGBoost. XGBoost dilatih menggunakan kombinasi teknik Grid Search dan K-Fold Cross Validation dengan nilai 𝐾 = 10. Terdapat 4 metrik yang dijadikan objektif optimisasi Grid Search, yaitu akurasi, sensitivitas, spesifisitas, dan skor AUC. XGBoost yang dilatih dengan mengoptimasi akurasi berhasil mencapai nilai akurasi sebesar 0,954, sensitivitas sebesar 0,935, spesifisitas sebesar 0,96, dan skor AUC sebesar 0,947. XGBoost yang dilatih dengan mengoptimasi sensitivitas berhasil mencapai nilai akurasi sebesar 0,966, sensitivitas sebesar 0,977, spesifisitas sebesar 0,963, dan skor AUC sebesar 0,97. XGBoost yang dilatih dengan mengoptimasi spesifisitas berhasil mencapai nilai akurasi sebesar 0,962, sensitivitas sebesar 0,931, spesifisitas sebesar 0,971, dan skor AUC sebesar 0,951. Kemudian XGBoost yang dilatih dengan mengoptimasi skor AUC berhasil mencapai nilai akurasi sebesar 0,955, sensitivitas sebesar 0,935, spesifisitas sebesar 0,962, dan skor AUC sebesar 0,948.

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Cardiovascular diseases (CVD) is one of the major causes of death in the world. WHO estimated that 17.9 million of deaths during 2021 are caused by CVD. In Indonesia alone, the prevalence of heart diseases reached 1.5% or around 2,7 million people in 2018. CVD consists of various types of heart disease. Congestive heart failure is one of them. Congestive heart failure (CHF) is a condition where the heart cannot pump enough blood for the entire body. CHF can occur due to a weakening of the heart muscle's ability to pump blood, thereby affecting the human heart rate. Heart rate can be represented using signal that can be measured using electrocardiogram (ECG/EKG) recording. EKG is a recording of the heart's electrical activity captured through the surface of the body. Heart rate variability (HRV) have been known to be correlated with various heart diseases with CHF is one of it. With the advance of technology, there have been various research regarding the implementation of artificial intelligence (AI) to detect the presence of CHF using machine learning model and HRV as features for the model. In this research, we built and evaluated the performance of XGBoost model to detect the existence of CHF on short-term HRV from 5 minutes EKG recording. The dataset came from four different databases that can be accessed from PhysioNet website. Those are NSRDB and NSR2DB datasets to represent healthy class and CHFDB and CHF2DB to represent CHF class. Each database contains long-term EKG. All records are segmented by 5 minutes on the first 2 hours of the recording. HRV metrics are calculated from those 5 minutes segments to become features for the XGBoost model. XGBoost was trained using a combination of Grid Search and K-Fold Cross Validation techniques with 𝐾 = 10. There are 4 metrics that become the objective scoring function for the Grid Search. Those are accuracy, sensitivity, specificity, and AUC score. XGBoost trained to optimize accuracy managed to achieve 0.954 accuracy, 0.935 sensitivity, 0.96 specificity, and 0.947 AUC score. XGBoost trained to optimize sensitivity managed to achieve 0.966 accuracy, 0.977 sensitivity, 0.963 specificity, and 0.97 AUC score. XGBoost trained to optimize specificity managed to achieve 0.962 accuracy, 0.931 sensitivity, 0.971 specificity, and 0.951 AUC score. Lastly, XGBoost trained to optimize AUC score managed to achieve 0.955 accuracy, 0.935 sensitivity, 0.962 specificity, and 0.948 AUC score."

"ABSTRAKLatar Belakang: Prevalensi gagal jantung semakin meningkat per tahun, 60-70% disebabkan penyakit jantung koroner (PJK). Beberapa faktor risiko penyebab gagal jantung yaitu DM, hipertensi, obesitas, sindrom metabolik, dan aterosklerosis. Patofisologi gagal jantung sangat kompleks dan melibatkan banyak sistem, terjadi hipermetabolisme yang dapat menyebabkan penurunanberat badan dan memicu terjadinya malnutrisi. Keadaan gagal jantung dekompensasi akut karena infark miokard lama membutuhkan penanganan segera di RS untuk menghindari komplikasi lebih lanjut.Metode: Laporan serial kasus ini memaparkan empat kasus pasien gagal jantung dekompensasi akut karena infark miokard lama, berusia antara 41 hingga 70 tahun, dan tiga diantaranya dengan riwayat DM tipe II. Semua pasien memerlukan dukungan nutrisi, tiga pasien memiliki status gizi obesitas dan satu pasien berat badan normal. Masalah berkaitan erat pada nutrisi keempat pasien adalah hipoalbuminemia, gangguan elektrolit, gangguan fungsi ginjal, gangguan fungsi hati, keseimbangan cairan, serta defisiensi mikronutrien. Perhitungan kebutuhan energi basal (KEB) dihitung berdasarkan rumus Harris Benedict dengan faktor stres sesuai kondisi klinis dan penyakit penyerta. Komposisi makronutrien diberikan menurutrekomendasi Therapeutic Lifestyle Changes (TLC) dan American Heart Association (AHA), pemberian protein disesuaikan dengan fungsi ginjal masing-masing pasien. Pemberian suplementasi mikronutrien juga diberikankepada keempat pasien. Pemantauan pasien meliputi keluhan subyektif, hemodinamik, analisis toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan dan kapasitas fungsional.Hasil: pemantauan selama di RS, keempat pasien menunjukkan perbaikan klinis, peningkatan toleransi asupan, perbaikan kadar elektrolit dan peningkatan kapasitas fungsional.Kesimpulan: Terapi nutrisi medik yang adekuat dapat memperbaiki kondisi klinis pasien gagal jantung dekompensasi akut karena infark miokard lama.

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ABSTRACT

Background: The prevalence of heart failure increase annually, 60-70% due to coronary heart disease (CHD). Some of the risk factors associated with heart failure are diabetes, hypertension, obesity, metabolic syndrome, and atherosclerosis. The phatophysiology of heart failure is very complex and involves many systems. The occurance of hypermetabolism can lead to weight loss and triger malnutrition. The state of acute decompensated heart failure due to old myocardial infarction require immediate treatment in hospital to avoid further complications.

Methods: This series of case report describes four cases of patients with acute myocardial heart failure, due to old infarction, aged between 41 to 70 years old, and three of them with a history of type 2 diabetes melitus. All patients required nutritional support, three patients had nutritional status of obese and one patient was normal in weight. The problems which closely linked to all nutrition of the four patients were hypoalbuminemia, electrolyte disturbances, impaired renal function, impaired liver function, fluid inbalance, and micronutrient deficiencies. Basal Energy Requirement was calculated using Harris Benedict formula with stress factors corresponding clinical condition and comorbidities. Macronutrients composition was given according to the recommendation of the Therapeutic Lifestyle Changes (TLC) and the American Heart Association (AHA), while the provision of proteins was

tailored with the kidney function of each patient. Micronutrients supplementation was also given to four patients. Patient monitoring parameters included subjective complaints, hemodynamic, analysis tolerance

of intake, laboratory tests, anthropometric, fluid balance and functional capacity.

Results: During the monitoring period in the hospital four patients showed clinical improvement, increased tolerance of intake, improved electrolyte levels and increased functional capacity.

Conclusion:Adequate medical nutrition therapy can improve the clinical condition of patients with acute decompensated heart failure due to old myocardial infarction."

"Latar Belakang: Infeksi COVID-19 merupakan penyakit dengan komplikasi multi-organ, salah satunya komplikasi kardiovaskular. Dengan kejadian gagal jantung akut sebagai komplikasi COVID-19 dengan mortalitas dan morbiditas yang tinggi, perlu dilakukan identifikasi faktor-faktor yang berhubungan dengan terjadinya gagal jantung akut pada pasien COVID-19, khususnya pada derajat sedang – berat.Tujuan : Mengetahui prediktor gagal jantung akut pada pasien COVID-19 yang dirawat, khususnya derajat sedang – beratMetode : Metode penelitian bersifat kohort retrospektif. Luaran primer adalah kejadian gagal jantung akut saat perawatan. Terdapat 15 faktor klinis dan laboratoris yang dianalisis secara bivariat dan multivariat.Hasil: Dari total 208 subjek sesuai kriteria inklusi dan eksklusi, sebanyak 73 subjek (35%) mengalami episode gagal jantung akut saat perawatan. Riwayat gagal jantung kronik memiliki risiko 5,39 kali (95% IK: 1,76 – 16,51; p = 0,003) mengalami kejadian gagal jantung akut. Pasien dengan nilai TAPSE < 17 mm memiliki risiko 4,25 kali (95% IK: 1,13 – 16,07; p= 0,033) mengalami gagal jantung akut. Sedangkan pemakaian ACE-i/ARB memiliki risiko 0,16 kali (95% IK: 0,05 – 0,51; p = 0,002) untuk mengalami gagal jantung akut intraperawatan dibandingkan kelompok tanpa pemakaian ACE-i/ARB.Kesimpulan: Riwayat gagal jantung kronik, TAPSE < 17 mm, dan pemakaian ACE-i/ARB diidentifikasi sebagai prediktor kejadian gagal jantung akut pada pasien COVID-19.

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Introduction: COVID-19 infection is a disease with multi-organ complications, including cardiovascular organ. As heart failure is one of COVID – 19 complications that has high morbidity and mortality, we need to identify factors that can predict acute heart failure in COVID – 19, especially in moderate to severe patients.

Objective : to determine predictors of acute heart failure in hospitalized COVID -19 patients

Method : This was a retrospective cohort study. The primary outcome was acute heart failure that happened during hospitalization. There were total of 16 clinical (age, sex, body mass index, hypertension, diabetes, smoking history, coronary artery disease, chronic kidney disease, chronic heart failure, chronic obstructive pulmonary disease, PaO2/FiO2 ratio, non-cardiogenic shock at admission, use of ACE-inhibitors/ARBs during hospitalization, ejection fraction, TAPSE) as well as 6 laboratory parameters (neutrophil - lymphocyte ratio, platelet - lymphocyte ratio, eGFR, D-Dimer, procalcitonin, CRP) that were used in statistical analysis.

Result: From total of 208 subjects with moderate – severe COVID-19, 73 (35%) had acute heart failure. The median time of developing heart failure is 4 ( 1 - 27) days. On multivariate analysis, patients with history of chronic heart failure exhibited a 5.39-fold higher risk of acute heart failure compared with no history of chronic heart failure (95% CI: 1.76 – 16.51; p = 0.003). The risk of acute heart failure was multiplied by 4.25 in patients that was presented with TAPSE <17 mm (95% CI: 1.13 – 16.07; p= 0.033). In contrast, use/continuation of ACE-inhibitors/angiotensin receptor blockers during hospitalization showed reduced risk of acute heart failure (16% of the risk developing acute heart failure compared with patients with no use of ACE-inhibitors/angiotensin receptor blockers). In subjects developing acute heart failure, the mortality rate was 67%, compared with 57% in subjects without acute heart failure (p = 0,028).

Conclusion: History of chronic heart failure, TAPSE <17 mm, and the use of ACE-inhibitors/angiotensin receptor blockers were identified as predictors of acute heart failure in hospitalized COVID-19 patients."

"ADHF (Acute decompensated heart failure) merupakan suatu kondisi gagal jantung dengan perubahan mendadak pada jantung untuk berkontraksi, sehingga mengancam nyawa dan dapat menyebabkan edema paru. Gagal jantung dapat dikategorikan menurut nilai ejeksi fraksi, salah satunya heart failure with reduce ejection fracktion (HFrEF) dengan nilai EF ≤40%. Tanda klinis ADHF salah satunya edema pada tungkai. Hal ini terjadi karena kegagalan LV untuk berkontraksi sehingga menyebabkan aliran balik dengan penumpukan cairan diparu, kemudian kembali ke RV dan keluar melalui atrium kanan ke seluruh tubuh, salah satunya ke tungkai. Intervensi yang dilakukan untuk mengatasi edema tungkai yaitu ankle pumping exercise. Intervensi ini dilakukan selama 3 hari dengan frekuensi 10 kali/jam, kemudian dievaluasi selama 6 jam dengan metode pitting edema. Hasil intervensi menunjukkan terdapat perubahan derajat edema tungkai dari +3/+3 menjadi +1/+2. Hasil karya ilmiah ini diharapkan menjadi salah satu alternatif intervensi untuk mengurangi edema tungkai.

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ADHF (Acute decompensated heart failure) is a condition of heart failure with sudden changes in the heart to contract, so it is life threatening and can cause pulmonary edema. Heart failure can be categorized according to the value of the ejection fraction, one of which is heart failure with reduced ejection fracture (HFrEF) with an EF value of ≤40%. One of the clinical signs of ADHF is edema in the legs. This occurs due to the failure of the LV to contract causing backflow with a buildup of fluid in the lungs, then back into the RV and out through the right atrium to the rest of the body, including the legs. The intervention to treat leg edema is ankle pumping exercise. This intervention was carried out for 3 days with a frequency of 10 times/hour, then evaluated for 6 hours using the pitting edema. The results of the intervention showed that there was a change in the degree of leg edema from +3/+3 to +1/+2. The results of this scientific work are expected to be an alternative intervention to reduce leg edema."