Hubungan antara Indeks Hemodinamik Akut dengan Kematian Selama Rawatan pada Pasien dengan Gagal Jantung Akut di RSUP Haji Adam Malik Medan

Abstract

Background: Acute heart failure remains a major health problem, characterised by high rates of rehospitalisation and mortality in patients. Several studies have shown that changes in haemodynamic parameters such as blood pressure, pulse pressure and heart rate can be predict mortality during hospitalisation in patients with acute heart failure. Acute haemodynamic index is a parameter that describes the body's ability to increase cardiac output in acute heart failure conditions. The purpose of this study was to determine the relationship between acute haemodynamic index and mortality during hospitalizaation in patients with acute heart failure admitted to the Hajj Adam Malik Hospital Medan. Methods: This study was conducted using the cross-sectional method on 167 patients with acute heart failure admitted to H. Adam Malik Hospital Medan from January 2023 to March 2024. Acute heart failure criteria were defined as a condition that arises suddenly or gradually from symptoms or signs of heart failure that are severe enough that patients need medical help according to ESC guidelines. Acute haemodynamic index was obtained by multiplying pulse pressure by heart rate divided by 1000. Data were analysed univariately, bivariately and multivariately using SPSS to assess the association of acute haemodynamic index with death during treatment with p<0.05 considered statistically significant. Results: Total study subjects of 167 patients, there were 32 deaths (19.2%) during hospitalisation and 135 patients were discharged to outpatient treatment. The mean value of acute haemodynamic index in this study was 4.86 + 2.46 mmHg.bpm. There was a significant association between acute haemodynamic index values and death during treatment in patients with acute heart failure (P = 0.004; OR = 3.512; 95% CI 1.540 - 8.005). Multivariate analysis was performed and found that acute haemodynamic index was an independent factor for death during treatment in patients with acute heart failure (P = 0.004; Exp B = 1.647; 95% CI 1.173 - 2.313). ROC curve analysis was performed and the acute haemodynamic index was found to be satisfactory with a p value = 0.001, AUC 0.667, and 95% CI (0.568 - 0.766). The AHI threshold value obtained was 3.905 mmHg.bpm, and had a sensitivity of 68% and specificity of 65.2%. Conclusion: Acute haemodynamic index can be a predictor of death during treatment in patients with acute heart failure.