Budhi Setianto
Departement of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

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Estimating The Annual Cost of Smoking-Related Diseases in Indonesia Sutrisna, Bambang; Surtidewi, Lujna; Jusuf, Anwar; Hudoyo, Ahmad; Kusmana, Dede; Setianto, Budhi; Purwaningsih, Endang
MEDIA MEDIKA INDONESIANA 2009:MMI VOLUME 43 ISSUE 5 YEAR 2009
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

Background: Smoking plays a role in the development of chronic diseases and causes substantial negative economic consequences. This study was carried out to estimate the annual cost of smoking-related cardio-cerebrovascular and pulmonary  diseases in the population by taking into account the direct costs associated with such co-morbid conditions in Indonesia.Methods: Meta-analysis using the Mix-Programme Software of the data of patients from university medical centers who were active smokers for more than a year and more than 20-pack years or passive smokers for more than a year and diagnosed with Coronary Heart Disease, Myocardial Infarction, Stroke, COPD, Chronic bronchitis, or Lung Cancer had been conducted. Annual direct cost was taken into account using the Decision Analysis Tree Age Pro (=DATA) software; cost data related to health care expenditure were derived from secondary data sources in Jakarta. In addition, Population Attributable Risk (PAR) for each comorbid conditions was calculated based on published epidemiological data from local and international journals.Results: One-hundred and eighty-seven patients (96% male) satisfying the inclusion criteria, were analyzed, of whom confirmed diagnosis of Stroke was amongst 29% of the patients, CHD 16%, Myocardial Infarction 16%, Lung Cancer 15%, COPD 17%, and Chronic Bronchitis 7%. Mean direct annual cost was highest for Lung Cancer (Rp 51.6 million) followed by Myocardial infarction (Rp 38.5 million) and CHD (Rp 37.8 million); PAR for various co-morbid conditions (based on variations in relative risk and smoking prevalence estimates) were: Stroke ~16%-26%, CHD ~17%-27%, MCI ~ 22%-33%, Lung Cancer ~ 17%-26%, COPD ~ 13%-21%, Chronic Bronchitis ~ 42%-59%.Conclusions: Annual cost of smoking-related diseases in Indonesia has been estimated. The highest cost is for Lung Cancer. The highest PAR is for Chronic Bronchitis.Keywords: Smoking-related diseases, Annual cost, Indonesia. ABSTRAKEstimasi pembiayaan per tahun penyakit terkait merokok di IndonesiaLatar belakang: Merokok berkaitan dengan kejadian berbagai penyakit kronis dengan konsekuensi ekonomi berupa biaya yang sangat banyak. Penelitian ini bertujuan untuk mengestimasi biaya dampak merokok pada berbagai kondisi ko-morbid terkait penyakit jantung, otak dan paru di masyarakat Indonesia.Metode: Meta-analisis dengan Mix-Programme software pada data sekunder penderita penyakit jantung iskemik, infark miokard, stroke, COPD, bronkitis kronis atau kanker paru dari Rumah Sakit Pendidikan Jakarta dengan kriteria : perokok aktif lebih 1 tahun dan merokok lebih 20 pak/tahun atau perokok pasif lebih 1 tahun. Cost-analysis dengan Tree Age Pro (=DATA) software dilakukan untuk membandingkan pengeluaran/biaya pengobatan per tahun menurut berbagai ko-morbid. Population Attributable Risk (PAR) untuk kondisi ko-morbid merujuk perhitungan yang ada pada jurnal epidemiologi lokal maupun internasional.Hasil: Seratus delapan puluh tujuh=187 pasien (96% laki-laki) memenuhi kriteria inklusi; diantaranya 29% pasien menderita stroke, 16% penyakit jantung iskemik, 16% infark miokard, 15% kanker paru, 17% COPD, dan bronkitis kronis 7%. Rerata pengeluaran biaya per tahun tertinggi adalah kanker paru (Rp 51,6 juta), diikuti penyakit jantung iskemik (Rp 37,8 juta); dan infark miokard (Rp 38,5 juta). PAR untuk masing-masing kondisi komorbid sebagai berikut: stroke 16-26%, penyakit jantung iskemik 17-27%, infark miokard 22-33%, kanker paru 17- 26%, COPD 13-21%, dan bronkitis kronis 42-59%.Simpulan: Pengeluaran biaya per tahun tertinggi untuk penyakit terkait dampak merokok adalah kanker paru-paru dan bila PAR terbesar pada bronkitis kronis.
Exercise Training and Vascular molecular Responses Sarvasti, Dyana; Radi, Basuni; Setianto, Budhi; Kusmana, Dede; Joesoef, Andang H
Jurnal Kardiologi Indonesia Vol 34, No 4 (2011): Vol 32, No 4 (2011): Oktober-Desember 2011
Publisher : Indonesian Heart Association

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Abstract

Regular physical activity (exercise training, ET) has a strong positive link with cardiovascular health. The beneficial effects of ET on the endothelium arteries are believed to result from increased vascular shear stress during ET bouts. A number of mechanosensory mechanisms have been elucidated that may contribute to the effects of ET on vascular function. Exercise training also consistently improves the nitric oxide bioavailability, and the number of endothelial progenitor cells, and diminishes the level of inflammatory markers, namely proinflammatory cytokines and C-reactive protein. This review summarizes current understanding of control of vascular adaptation by exercise and how these processes lead to improved cardiovascular health
Electrocardiogram Predictors of Left Main Disease in Patients with Acute NSTEMI Nagawidjaja, Budiyanto; Purnomo, Hadi; Setianto, Budhi
Jurnal Kardiologi Indonesia VOL. 28 NO. 4 September 2007
Publisher : Indonesian Heart Association

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Abstract

Background. The importance to identify Left Main (LM) disease in Coronary Artery Disease (CAD) patients is to define therapy strategy, prognosis which can influence to length of hospitalization, survival rate, and the payment. Electrocardiogram (ECG) is a simple tool to diagnose patient with CAD.Objectives. To identify ECG indicators as related to LM disease predictors.Methods. 265 acute non ST elevation patients enrolled after having coronary angiography in National Cardiovascular Center Harapan Kita Jakarta. ST elevation, ST depression, T invertion of the 12 lead ECG and ST elevation in aVR taller than V1 lead is further variable investigation. Chi-square and Mann-Withney test were done for statistical analysis. Logistic regression was used in variable predictor test. Discrimination test was done by using Hosmer Lemeshow goodness of fit to determine validation model and area under curve test.Results. The largest populations were male (210 patients – 82.3%). The age range from 37 until 80 years old (mean 59,9 ± 9,1 years), 77 patients were more than 65 years old. There were 90 patients with LM disease. There was ST elevation in aVR in 88 patients, and 87 patients had higher ST elevation compared to ST segment in V1. The significant factors are elevation of ST segment in aVR, ST segment elevation in aVR > V1, ST depression in I, II, III, aVL, aVF, V2 - V6, ST elevation in lead aVR–V1, multiple ST changes (elevation and depression) in many leads. Multivariate analysis showed the highest parameter to diagnose LM disease are ST elevation in aVR and ST elevation aVR-V1 (mm) with area under curve 96% (sensitivity 92,22 / specificity 97,14 / PPV 94,31 / NPV 96,00 for ST elevation in aVR and sensitivity 93,33 / specificity 98,29 / PPV 96,55 / NPV 96,62 for ST elevation aVR>V1).Conclusions. ECG indicators for LM disease are ST elevation in aVR and ST elevation in aVR>V1.
Predictive Value of Terminal QRS Distortion in Anterior Wall Acute Myocardial Infarction Masrul, dr; Setianto, Budhi; Haryono, Nur
Jurnal Kardiologi Indonesia Vol.28 No.3 Mei 2007
Publisher : Indonesian Heart Association

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Background. The initial ECG at patients with Acute Coronary Syndrome, especially STEMI can predict size of infarction, response to reperfusion therapy and long term prognosis. A new classification, the QRS distortionhave increased mortality rates and larger infarct size and less limitation of their infarct size by thrombolytic therapy. QRS distortion is the emergence of J point = 50% of R wave in leads with qR configuration (I, aVL, V4-V6), or disappearance of the S wave in leads with Rs configuration (V1-V3).Methods and results. This study is cohort-retrospective to patients with anterior IMA treated by thrombolytic at National Cardiovascular Centre – Harapan Kita, Jakarta, Indonesia, during January 2003 – September 2004,that fulfill inclusion and exclusion criterias. They were divided into two group, with QRS distortion (+) and without QRS distortion (-); each group consist of 30 patients. Correlation between the two groups were analyzed by t test, chi-square test, Mann Whitney u test and logistic regression.Patients age range is 40 – 69 years, and mostly man. There is no difference between baseline characteristic in the two groups, except cholesterol LDL which is higher in the group with QRS distortion. Patients with QRS distortion have a higher tendency of thrombolytic therapy failure compare to patients without QRS distortion, (p=0,003). As the consequence they also have a higher rate of arrhythmia events, low ejectionfraction and re-hospitalization due to congestive heart failure.Conclusions. The prognosis of patients with anterior IMA associated with QRS distortion is worse than without QRS distortion.
Relationship Between Job Strain and Myocardial Infarction in The National Cardiovascular Center Patients Melati, Rima; Basuki, Endang; Setianto, Budhi
Jurnal Kardiologi Indonesia Vol 29 No 1, Jan-April 2008
Publisher : Indonesian Heart Association

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Background. Coronary heart disease is the most frightening disease and still become a problem in the developed and developing countries. The prevalence of myocardial infarction is also increasing from year to year. Beside the conventional risk factors, it is also influenced by occupational factors. Although job strain can cause stress which would have impact on the occurence of myocardial infarction, the prevention strategies being implemented are just for conventional risk factors. There is still no concern for occupational factors which can also cause job strain. This study was aimed to assess the relationship between job strain and other risk factors with myocardial infarction among workers.Methods. The study design was matched case – control 1:1 for age. Data were collected by using general questionnaire which covered demography characteristics, conventional risk factors, job characteristics, and demand – control questionnaire (JCQ) to assess job strain.Result. Job strain, smoking and dyslipidemia were risk factors which had relationship with myocardial infarction. Job strain increased myocardial infarction risk by 6.8 times (Adj OR 6.80, 95% CI: 2.72 ; 16.98, p = 0.000). Light smokers increased myocardial infarction risk by 15 times (Adj OR 14.97, 95% CI: 3.17 ; 70.74, p = 0.001), medium smokers increased myocardial infarction risk by 7.7 times (Adj OR 7.72, 95% CI: 2.73 ; 21.84, p = 0.000), and heavy smokers increased myocardial infarction risk by 26 times (Adj OR 25.61, 95% CI: 5.25 ; 124.88, p = 0.000). Dyslipidemia increased myocardial infarction risk by 2.8 times (Adj OR 2.82, 95% CI: 1.07 ; 7.44, p = 0.035). Job strain component which increased myocardial infarction risk was high job demand (Adj OR 2.44, 95% CI: 1.02 ; 5.85, p = 0.046).Conclusion. Job strain, smoking and dyslipidemia simultaneously had relationship with myocardial infarction.Keywords. Job strain, myocardial infarction, smoking, dyslipidemia
Pemulihan Laju Jantung pada penyakit jantung hipertensi Setianto, Budhi
Jurnal Kardiologi Indonesia Vol 29, No 3 (2008): September-Desember 2008
Publisher : Indonesian Heart Association

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Penelitian disfungsi autonom menggunakan tes treadmil pada fase pemulihan laju jantungnya pada fenomena menurunnya heart rate recovery memang lazim.1 Kizilbash MA tahun 2006, telah menelitinya pada sindroma metabolik, menyimpulkan terjadinya disfungsi autonom pada komponen metabolik sindrom: tekanan darah, trigliserid, lingkar perut dan LDL-C.2 Dengan metode lainnya, yaitu standard deviation of RR intervals (SDNN), Wu JS3 telah melaporkan penelitiannya bahwa disfungsi parasimpatis telah ada pada normotensi dengan riwayat keluarga hipertensi, juga tampak pada pre-hipertensi dan hipertensi. Perubahan peranan syaraf otonom dengan penguatan simpatis lebih nyata pada kasus pre-hipertensinya. Peningkatan aktivitas simpatis dan penurunan aktivitas parasimpatis yang timbul pada gagal jantung secara klinis memiliki relevansi dengan progresifitas penyakit serta mortalitas pasien-pasien dengan gagal jantung kronis. Stimulasi simpatis yang berlebihan meningkatkan kerja sistem kardiovaskular, memberi beban terhadap hemodinamik tubuh serta merupakan predisposisi terjadinya disfungsi endotel, spasme koroner, hipertrofi ventrikel kiri, serta disritmia, termasuk kejadian henti jantung mendadak melalui instabilitas listrik jantung.4-6
Revolusi Genomik dan Masa Depan Kardiologi (Preventif) Ilustrasi Kasus: Penyakit Jantung Koroner pada Kembar Identik Raharjo, Sunu Budhi; Joesoef, Andang Hamiarsa; Setianto, Budhi
Jurnal Kardiologi Indonesia Vol 30, No 2 (2009): Mei-Agustus 2009
Publisher : Indonesian Heart Association

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The Simon Dack Lecture, salah satu sesi paling bergengsi dari pertemuan ilmiah tahunan The American College of Cardiology secara berturut-turut menampilkan tiga pembicara dengan latar belakang yang berbeda, tetapi memberikan pesan yang senada dan saling memperkuat. Diawali pada tahun 2003, Dr. Eugene Braunwald, mahaguru kardiologi, memberikan pandangannya mengenai Cardiology: The Past, The Present and The Future 1; kemudian tahun 2005, Dr. Eric Topol, ahli jantung intervensi dari California, memberikan kuliah dengan judul The Genomic Basis of Myocardial Infarction 2, dan pada tahun 2006, Dr. Elizabeth Nabel, Direktur NHLBI (National Heart Lung and Blood Institute), menyampaikan visinya dengan topik Genomic Medicine and Cardiovascular Disease 3. Ketiga dedengkot kardiologi Amerika itu ternyata memiliki visi yang serupa dalam melihat kardiologi di masa depan: bahwa revolusi genomik akan memberikan kontribusi yang signifikan dalam perkembangan ilmu dan praktek kardiologi di masa yang akan datang. Tulisan ini mencoba menyarikan perspektif ketiga tokoh kardiologi dunia tersebut, disertai ilustrasi kasus yang ada di tanah air untuk menggambarkan bahwa perspektif yang mereka berikan sangat relevan dengan situasi di tanah air, serta ditambah beberapa referensi terkini, untuk melihat masa depan kardiologi, utamanya kardiologi preventif.
Kejadian Kardiovaskular Mayor pada Perempuan Setianto, Budhi
Jurnal Kardiologi Indonesia Vol 30, No 1 (2009): Januari-April 2009
Publisher : Indonesian Heart Association

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Adalah menarik untuk membagi usia muda dan tua bagi seorang wanita dalam wawasan faktor risiko. Faktor risiko (usia) penyakit jantung koroner untuk pria adalah >45 tahun dan wanita >55 tahun, wanita terlambat 10 tahun dibanding pria karena berbagai teori, antara lain hormonal seperti estrogen dan ferritine. Danny SS membagi wanita dalam penelitiannya sebagai kelompok usia muda bila <55 tahun dan kelompok usia tua >55 tahun. Apakah wanita berumur 56 tahun sudah pantas dikelompokkan sebagai usia tua?. Perhatikan kesimpulan pada penelitian ini: ... IMA pada kelompok wanita usia muda merupakan kelompok risiko tinggi yang memiliki spektrum penyakit tersendiri yang sulit diprediksi oleh faktor risiko tradisional. Perlu diperhatikan faktor risiko yang masih “primordial” seperti sindroma metabolik.1 dan prediabetes, menarik perhatian akhir-akhir ini. Menurut Polk dan Naqvi, pada wanita, faktor risiko yang perlu diperhatikan adalah diabetes mellitus, rendahnya kadar kolesterol HDL, tingginya kadar trigliserid dan depresi.2
Jantung Sehat ? Setianto, Budhi
Jurnal Kardiologi Indonesia Vol 30, No 1 (2009): Januari-April 2009
Publisher : Indonesian Heart Association

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“Adalah hak pribadi seseorang untuk menyebut dirinya sehat (klien) atau sakit (pasien) jantung, biarkanlah dokter membantunya untuk beradaptasi dengan lingkungan yang unik” (Makna paralel dari “Proklamasi” Kardiologi Sosial, 25 Juni 1993). Sehat secara keseluruhan yang telah dicanangkan WHO sejak didirikan 1946, yaitu “keadaan sehat yang komplit baik fisik, mental, dan sosial”, terus dilanjutkan dengan “bebas dari sakit atau keterbatasan/cacat”. Kemudian dimunculkan konsep “Kesehatan untuk semua” di Tahun 2010, 2020, dst. Belum ada definisi baru ketika kita sudah memasuki era biologi molekuler, yang dihubungkan dengan masalah individu dan sosial. Semakin kita menyadari pentingnya pengaruh genom dalam suatu penyakit dan menyodorkan konsep sehat, ternyata masih ada yang tidak mungkin, yaitu bebas dari faktor-risiko penyakit jantung. Karena gender pria dan umur lanjut termasuk faktor risiko.
Nilai prognostik dispersi qt pasca bedah pintas koroner Setianto, Budhi
Jurnal Kardiologi Indonesia Vol 31, No 2 (2010): Mei-Agustus 2010
Publisher : Indonesian Heart Association

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Hubungan antara dispersi QT pascabedah pintas arteri koroner dengan kejadian kardiovaskuler telah diteliti akhir-akhir ini oleh Agustinus dkk1 dari Departemen Kardiologi dan Kedokteran Vaskuler FKUI di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita secara restropektif dengan kesimpulan yang menarik perhatian untuk diberikan komentar. Bahwa dispersi QT > 60 milidetik pada subyek pasca BPAK telah meningkatkan risiko terjadinya kejadian kardiovaskular mayor, gagal jantung akut dan sindroma koroner akut non fatal dalam pemantauan selama 1 tahun.