Accp 12 presentation efta

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Efta Triastuti, M.Farm.Klin., Apt. Study Program of Pharmacy, Faculty of Medicine, Brawijaya University Malang-Indonesia

Transcript of Accp 12 presentation efta

Page 1: Accp 12 presentation efta

Efta Triastuti, M.Farm.Klin., Apt.

Study Program of Pharmacy, Faculty of Medicine, Brawijaya University

Malang-Indonesia

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Heart Failure

Various heart

diseases

Heart function

impairment

Clinical syndromes

Quality of life reduction

High morbidity

High mortality

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Therapeutic Guideline

AHA

SIGN

NICE

Previous studies

CIBIS

BEST

MERIT-HF

SENIORS

COPERNICUS

Improve QOL

Reduce Mortality

Reduce Morbidity

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β blocker

surge of βadrenergic activity

in heart failure

BISOPROLOL

High β1 affinityLow effect on bronchus

No ISANo MSA

Available in Indonesia

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EF

QOL

Left ventricular function

Systolic heart failure

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Dr Saiful Anwar General Hospital

Cardiovascular Ambulatory Clinic

Bisoprolol

3 months Followed up

Checked “baseline” Ejection Fraction & Quality of Life Questionnaire score

Checked “endpoint” Ejection Fraction & Quality ofLife Questionnaire score

1317

Stage C Systolic Heart Failure Patients

Receiving Combination of ACE Inhibitor & Furosemide

40-80 Years of Age (n=30)

Quasi-experimental study used a one group pretest-posttest design

Added on

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Stage C chronic & stable heart failure

Had Ejection Fraction reduction (EF < 50%)

Receiving optimum dose of ACE inhibitor and furosemide

Fulfill for Bisoprolol indication

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Already accepted Bisoprololbefore recruitment

Acute heart failure and needed positive inotropic except digoxin

Comorbid condition which affect to quality of life such as mitral regurgitation, atrial fibrilation, & cardiogenic shock

Bradycardia (heart rate below 60 times per minute)

Hypotension with systolic pressure below 100 mmHg Severe asthma

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Measured by two experts in operating Echocardiography

Simpson method of measurement as a gold standard

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MinessotaLiving with

Heart Failure Questionnaire

21 questions each contained 6 choice

answers based on the symptom frequencies

The more frequent symptoms the higher questionnaire score

The worse heart failure condition & the higher

impact on QOL

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Mean Baseline

EF

Mean Endpoint

EF

Mean Baseline MLHFQ

score

Mean Endpoint MLHFQ

score

Comparison method:Gaussian distribution pair t-test analysisNon-Gaussian distribution Wilcoxon analysis

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30 subjectsEligible

Inclusion & exclusion

criteria screening

February -October

2011

Subjects recruitment

EF & QOL

Sex

Age

Comorbid disease Chi-Square

Analysis

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Percentage (%) P value

Sex:MaleFemale

73.326,7

0.465

Age:40 to 50 years old51 to 60 years old61 to 70 years old71 to 80 years old

13.3304016,7

0.141

History of previous illness:HypertensionIschemic heart disease + HTDiabetes Mellitus + HT

26.753.320

0.061

P > 0.05 No significant

contribution between those factors to EF or

QOL

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05

1015

202530354045

Baseline 3rd monthsMea

n Ej

ecti

on F

ract

ion

Perc

enta

ge

(%)

Time of Measurements (before & after BisoprololAddition)

Baseline

3rd months

EF percentage (%) P valueMean baseline 35.20 ± 8.98

0.000Mean at 3rd months 42.80 ± 10.15

Mean EF did not meet Gaussian Distribution

Non-parametric test comparison

One group pretest-posttest design

Wilcoxon analysis

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44

46

48

50

52

54

56

Baseline 3rd months

Mea

n Q

OL

Que

stio

nnai

re S

core

Time of Measurements (before & after Bisoprolol Addition)

Baseline

3rd months

Mean QOL Questionnaire Score P value

Mean baseline 54.93 ± 9.610.000

Mean at 3rd months 48.27 ± 8.57

Mean QOL questionnaire score met Gaussian Distribution

Parametric test comparison

One group pretest-posttest design

Paired t test analysis

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Bisoprolol

Decrease heart rate

Cardiac oxygen demand

reduction

ischemic-related symptoms relieve

QOL improvement

Adequate filling &

loading time

Increase cardiac output by increasing stroke volume though heart rate decline

Increase Ejection Fraction by reduce blood volume which

left in the ventricle

Inhibit renin

release

Aldosterone antagonistic

effect

Decrease water & sodium retention

Cardiac load reduction

Slow down HF-related cardiomyopathy progression

No ISA high effect on HR reduction

No MSA minimum effect on cardiac conductance

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