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Supriyana DS, Prasetyawati AE, Arifianto H. Combination Electroacupuncture and Guidelines Directed Medical Therapy Maintained Stability of Heart Rate and Mean Arterial Pressure in Heart Failure with Reduced Ejection Fraction. Med Acupunct 2023; 35:296-304. [PMID: 38162549 PMCID: PMC10753942 DOI: 10.1089/acu.2023.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background Clinical studies have shown that electroacupuncture (EA) has therapeutic and modulatory effects on managing heart failure (HF) risk factors. Objective This study aimed to determine the impact of combination drugs and EA on chronic HF patients with reduced ejection fraction (HFrEF) to maintain a stable heart rate (HR) and mean arterial pressure (MAP). Materials and Methods This single-blind clinical randomized controlled trial included 42 patients with chronic HFrEF. The patients were divided into 3 groups: patients taking drugs and EA, patients taking drugs and sham EA (sham acupuncture [SA]), and patients taking drugs without EA. All patients underwent 16 sessions of therapy for 8 weeks. Results There was a significant difference in the average MAP based on therapy duration in the drugs + EA group, whereas there was no significant difference between drugs + SA and drugs without EA groups. There was a substantial difference between the average MAP in the drugs + EA group at the beginning of therapy compared with that at midtherapy (P < 0.05) and at the beginning of treatment and at the end of therapy (P < 0.05). There was no significant difference in the mean HR between the groups. Clinically, after 16 treatment sessions, patients receiving combined drugs and EA treatment presented with stable MAP and HR. Conclusions Drugs combined with EA maintained the stability of MAP and HR in patients with chronic HFrEF.
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Affiliation(s)
- Dwi Surya Supriyana
- Department of Medical Acupunture, Medical Acupuncture Physician, Faculty of Medicine, Universitas Sebelas Maret, Surakarta/Medical Acupuncture Division, Universitas Sebelas Maret Teaching Hospital, Surakarta, Indonesia
| | - Arsita Eka Prasetyawati
- Master of Public Health, Family Medicine Physician, Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Habibie Arifianto
- Cardiovascular Imaging Consultant, Heart Failure Physician, Sebelas Maret Heart Failure Clinic, Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret/Universitas Sebelas Maret Teaching Hospital, Surakarta, Indonesia
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Nauli SE, Prima Putri VK, Arifianto H, Prameswari HS, Lubis AC, Zulkarnain E, Hasanah DY, Dewi Yamin PP, Dewi TI. Heart Failure With Preserved Ejection Fraction: Current Status of Daily Clinical Practice in Indonesia. Cureus 2023; 15:e38086. [PMID: 37257168 PMCID: PMC10209474 DOI: 10.7759/cureus.38086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Heart failure (HF) is a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. Among HF types, HF with preserved ejection fraction (HFpEF) is the commonest form. However, the diagnosis and management of HFpEF are challenging. In addition, the perception of healthcare professionals (HCPs) towards the diagnosis and management of HFpEF patients differs due to the existing gap between the guidelines and daily clinical practice. Therefore, an online survey was conducted to understand the HCPs' knowledge and practice gaps in the diagnosis, treatment, and management of patients with HFpEF. Methods A total of 160 respondents, i.e., cardiologists, internists, and cardiology residents from different community-based practices and hospitals across Indonesia participated in an online continuing medical education (CME) survey. A questionnaire was formulated to assess awareness, current practice patterns, challenges, and confidence of the HCPs related to the HFpEF. Results HCPs stated that diagnosis of HF is the prime responsibility of cardiologists and general physicians but not of general internists. According to the HCPs, reduction in mortality, reduction in hospitalization, and improved quality of life are the most important goals of HF treatment. The perceived prevalence of HFpEF is estimated to be 30-60% and mortality rates of HFpEF and HF with reduced ejection fraction (HFrEF) are similar. Further, mixed types of responses with different combinations of diagnosis, treatment, and prevention, were obtained when HCPs were asked about the challenges faced in HFpEF. Among the therapies, angiotensin-converting enzyme (ACE) inhibitors, mineralocorticoid receptor antagonists (MRA), beta-blockers, and diuretics are frequently used for the treatment of HF. Conclusion The perception of the HCPs toward the diagnosis and management of HFpEF may affect optimal care. Based on our findings, the cardiologists are well aware of the current situation of HF in Indonesia and treat patients with HFpEF effectively.
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Affiliation(s)
- Siti E Nauli
- Department of Cardiology, Tangerang District Hospital, Tangerang, IDN
- Working Group on Heart Failure and Cardiometabolic Disease, Indonesian Heart Association, West Jakarta, IDN
| | - Vebiona K Prima Putri
- Department of Cardiology, Awal Bros Hospital, Pekanbaru, IDN
- Working Group on Heart Failure and Cardiometabolic Disease, Indonesian Heart Association, West Jakarta, IDN
| | - Habibie Arifianto
- Department of Cardiology, Universitas Sebelas Maret Hospital, Surakarta, IDN
- Working Group on Heart Failure and Cardiometabolic Disease, Indonesian Heart Association, West Jakarta, IDN
| | - Hawani S Prameswari
- Department of Cardiology, Hasan Sadikin General Hospital, Bandung, IDN
- Working Group on Heart Failure and Cardiometabolic Disease, Indonesian Heart Association, West Jakarta, IDN
| | - Anggia C Lubis
- Department of Cardiology, Haji Adam Malik General Hospital, Medan, IDN
- Working Group on Heart Failure and Cardiometabolic Disease, Indonesian Heart Association, West Jakarta, IDN
| | - Edrian Zulkarnain
- Department of Cardiology, Mohammad Hoesin General Hospital, Palembang, IDN
- Working Group on Heart Failure and Cardiometabolic Disease, Indonesian Heart Association, West Jakarta, IDN
| | - Dian Y Hasanah
- Department of Cardiology, National Cardiovascular Center Harapan Kita, West Jakarta, IDN
- Working Group on Heart Failure and Cardiometabolic Disease, Indonesian Heart Association, West Jakarta, IDN
| | - Paskariatne P Dewi Yamin
- Department of Cardiology, Gatot Soebroto Central Army Hospital, Central Jakarta, IDN
- Working Group on Heart Failure and Cardiometabolic Disease, Indonesian Heart Association, West Jakarta, IDN
| | - Triwedya I Dewi
- Department of Cardiology, Hasan Sadikin General Hospital, Bandung, IDN
- Working Group on Heart Failure and Cardiometabolic Disease, Indonesian Heart Association, West Jakarta, IDN
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Ristiansah IH, Arifianto H, Irnizarifka, Ahmad F, Kusumastuti F, Hafika AN, Myrtha R, Wulandari EL. C87. Serial Cases of Cardiovascular Manifestation on Leptospirosis: A Tales of Unfortunate Events. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab124.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background
Leptospirosis is a zoonosis disease caused by Leptospira species. It's endemic and has become a major public health issue, especially in tropical regions. Clinical manifestation varies from mild or asymptomatic to severe multiple organ failure. We report cases of severe leptospirosis which complicates supraventricular tachycardia and myoperdicarditis from Universitas Sebelas Maret Academic Hospital.
Case Summary
The first case was a 44-year-old man referred from Internal Medicine Department with Leptospira infection with Weil’s disease. On 5th daycare, the patient was reporting had an episode of tachyarrhythmia, the ECG show SVT-AVNRT, there was no history of arrhythmic events before admitted to the hospital, the echocardiography was normal. The second case was a 67-year-old man who was referred from emergency department with shortness of breath, the ECG reveals diffuse ST-segment elevation in all limb and precordial leads with reciprocal ST-depression at aVR and V1, there was also downsloping of the PR and TP segment on precordial leads (Spodick’s sign), with normal ejection fraction on echocardiographic examination with pericardial thickening. Both patients have hsTroponin levels rose above the normal limit and serological testing found positive leptospira IgM.
Discussion
Severe leptospirosis can cause multi-organ dysfunction including cardiac involvement. The patients, in this case, suffered from leptospirosis with SVT-AVNRT and myopericarditis. The exact pathophysiology is still unclear, but there are several hypotheses, such as cytokine storms and direct damage from leptospira endotoxins. Arrhythmias and cardiac disturbance in leptospirosis patients are associated with poor outcomes and higher mortality rates.
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Affiliation(s)
- I H Ristiansah
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - H Arifianto
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - Irnizarifka
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - F Ahmad
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - F Kusumastuti
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - A N Hafika
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - R Myrtha
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - E L Wulandari
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
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Ristiansah IH, Arifianto H, Irnizarifka, Ahmad F, Kusumastuti F, Hafika AN, Myrtha R, Wulandari EL. C87. Serial Cases of Cardiovascular Manifestation on Leptospirosis: A Tales of Unfortunate Events. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab125.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Leptospirosis is a zoonosis disease caused by Leptospira species. It's endemic and has become a major public health issue, especially in tropical regions. Clinical manifestation varies from mild or asymptomatic to severe multiple organ failure. We report cases of severe leptospirosis which complicates supraventricular tachycardia and myoperdicarditis from Universitas Sebelas Maret Academic Hospital.
Case Summary
The first case was a 44-year-old man referred from Internal Medicine Department with Leptospira infection with Weil’s disease. On 5th daycare, the patient was reporting had an episode of tachyarrhythmia, the ECG show SVT-AVNRT, there was no history of arrhythmic events before admitted to the hospital, the echocardiography was normal. The second case was a 67-year-old man who was referred from emergency department with shortness of breath, the ECG reveals diffuse ST-segment elevation in all limb and precordial leads with reciprocal ST-depression at aVR and V1, there was also downsloping of the PR and TP segment on precordial leads (Spodick’s sign), with normal ejection fraction on echocardiographic examination with pericardial thickening. Both patients have hsTroponin levels rose above the normal limit and serological testing found positive leptospira IgM.
Discussion
Severe leptospirosis can cause multi-organ dysfunction including cardiac involvement. The patients, in this case, suffered from leptospirosis with SVT-AVNRT and myopericarditis. The exact pathophysiology is still unclear, but there are several hypotheses, such as cytokine storms and direct damage from leptospira endotoxins. Arrhythmias and cardiac disturbance in leptospirosis patients are associated with poor outcomes and higher mortality rates.
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Affiliation(s)
- I H Ristiansah
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - H Arifianto
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - Irnizarifka
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - F Ahmad
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - F Kusumastuti
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - A N Hafika
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - R Myrtha
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
| | - E L Wulandari
- Universitas Sebelas Maret Academic Hospital, Sukoharjo, Indonesia; Departement of Cardiology and Vascular Medicine, Departement of Internal Medicine, Faculty of Medicine, Sebelas Maret University , Surakarta, Indonesia
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Kusumastuti Irnizarifka F, Arifianto H, Ristiasah IH, Hafika AN, Myrtha R. OR77. The Struggle of Improving Ejection Fraction in Heart Failure, Does Patient Adherence Has a Significant Role? A Single-Centre Pilot Study from CORE-HF Registry. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab122.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Despite the development of its treatment, adherence is an important factor in reducing the mortality and morbidity of heart failure. This study aims to see the correlation between patient adherence and improvement of ejection fraction (EF) in a Heart Failure patients.
Method and Result
This is a retrospective cohort study held in HF Clinic UNS Hospital from CORE-HF (COmprehensive Registry and rEsearch on Heart Failure). The adherence was measured using MMAS-8. The total score was grouped into three categories; high = 8, moderate = 6 to < 8, and poor < 6. For HFrEF patient, the EF improvement within 12 months is grouped into; Recovery (EF evaluation > 50%), improved (EF evaluation > 40%), and none (EF evaluation < 40%). For HFmrEF and HFpEF, the change of EF is categorized into increased more than 10%, < 10%, and decreased. Among 130 patients, 47.7% have poor adherence, 58% moderate adherence, and 10% high adherence. The characteristics of the samples were 60.8% male, with a mean age of 57 years old, 10% with Atrial Fibrillation, 34.6% with CAD, 36% with HFrEF, 15% with HFmrEF, and 48% patients have HFpEF. Among HFrEF, the Kruskal-Wallis test showed a statistically significant difference in EF improvement between the adherence groups (χ2 (2) = 7.860; p = 0.02). This study also found a significant difference in EF improvement among adherence groups between HFmrEF and HFpEF (χ2 (2) = 9.159; p = 0.010)
Conclusion
Besides optimal medical therapy, patient adherence has an important role in improving EF.
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Affiliation(s)
- F Kusumastuti Irnizarifka
- UNS Academic Hospital, Sukoharjo, Indonesia; Cardiovascular Department of UNS Academic Hospital , Sukoharjo, Indonesia
| | - H Arifianto
- UNS Academic Hospital, Sukoharjo, Indonesia; Cardiovascular Department of UNS Academic Hospital , Sukoharjo, Indonesia
| | - I H Ristiasah
- UNS Academic Hospital, Sukoharjo, Indonesia; Cardiovascular Department of UNS Academic Hospital , Sukoharjo, Indonesia
| | - A N Hafika
- UNS Academic Hospital, Sukoharjo, Indonesia; Cardiovascular Department of UNS Academic Hospital , Sukoharjo, Indonesia
| | - R Myrtha
- UNS Academic Hospital, Sukoharjo, Indonesia; Cardiovascular Department of UNS Academic Hospital , Sukoharjo, Indonesia
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