Clinical Cardiology in South East Asia: Indonesian Lessons from the Present towards Improvement

Qanitha, Andriany; Qalby, Nurul; Amir, Muzakkir; Uiterwaal, Cuno S.P.M.; Henriques, José P.S.; Mol, Bastianus A. J. M. de; Mappangara, Idar

doi:10.5334/gh.1133

Cited by 12 publications

(18 citation statements)

References 50 publications

(81 reference statements)

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“…2 Scarcity of cardiologists in Indonesia was mentioned by Qanitha et al with a cardiologist and population ratio of 1:182.160, with 1485 cardiologists and 270 million people in Indonesia. 1 Despite the patient's routine control during her current pregnancy at a peripheral center with seven times antenatal care (ANC) with an obstetrician and cardiologist, the lack of standardization in healthcare providers and integration with central health care proves a sufficient number of ANC is still inadequate. Besides termination of pregnancy could be performed before she was referred or the disease progressed.…”

Section: Discussionmentioning

confidence: 99%

“…As previously stated by Qanitha et al authority in decisionmaking, ignoring the guideline standards, and poor management of after-discharge care are mainly the problems of cardiovascular care in Indonesia. 1 Managing PH in pregnancy requires a multidisciplinary effort by a specialized Pregnancy Heart Team. A Pregnancy Heart Team is led by providers from a cardiologist, maternal-fetal medicine, obstetric anesthesia, pharmacy, and nursing to provide a holistic approach to patient care while facilitating opportunities for cross-disciplinary education.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study reported that 70% of the population with moderate-to high-risk cardiovascular disease failed to access cardiovascular care. 1 Health system-wise, the Indonesian healthcare system is not yet designed to provide a one-stop holistic management of cardiac diseases in pregnancy. There is a big difference between evidence-based medicine and on-field practice.…”

Section: Introductionmentioning

confidence: 99%

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Dilemmas in pregnancies with pulmonary hypertension: Case report from a low-resource setting

Pusianawati,

Suryawan,

Tjandraprawira

et al. 2023

SAGE Open Medical Case Reports

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Little awareness persists of how pregnancy worsens cardiac diseases. We wish to highlight the challenges in managing pulmonary hypertension (PH) in pregnancy, within low socioeconomic environments. A 31-year-old G3P1A1 of 5 months gestation presented with worsening dyspnea and extremital edema. She had a history of heart disease with no cardiologist follow-up. She was diagnosed with type I/II PH at 4 months gestation. Her ultrasound revealed intrauterine fetal death (IUFD). She was referred for pregnancy termination. At presentation, she was tachypneic with SaO2 at 68%. After labor, she was transferred to a cardiac intensive care unit with SaO2 at 60%. Bedside echocardiography revealed a high probability of PH (pulmonary artery systolic pressure value: 109 mmHg). Unfortunately, she deteriorated and passed away a day later. Cardiac diseases in pregnancy contribute significantly to maternal mortality in Indonesia and other low socioeconomic countries. Traditional views on pregnancy and family and human rights advocate pregnancy as one of the rights, pregnancy complicated with cardiac diseases is detrimental and potentially lethal. Disparities in healthcare practices and low socioeconomic environments also contribute to such outcomes. Lack of awareness and improperly held beliefs on conception and family have led women to conceive amidst severe underlying cardiac diseases with dire outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dilemmas in pregnancies with pulmonary hypertension: Case report from a low-resource setting

Pusianawati,

Suryawan,

Tjandraprawira

et al. 2023

SAGE Open Medical Case Reports

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“…Most LMICs in the Southeast Asian Region, especially Indonesia, only provide 24-hour rescue or primary PCI at the tertiary or national level. 6,8 A study in Jakarta, the capital of Indonesia, found that between 2007 and 2013, PCI procedures increased from 24% to 35%, and non-reperfusion patients decreased from 67ꞏ1% to 62ꞏ8%.…”

Section: Acs Treatment In Lmicmentioning

confidence: 99%

“…In this paper, we will describe the growth, number, ratio, and distribution of cath labs in Indonesia with the expectation of it providing a basis for policy-making. [4][5][6]…”

Section: Introductionmentioning

confidence: 99%

Catheter Laboratory Facilities in Indonesia: Number, Growth, and Distribution in The Largest Archipelago Nation

Muharram

Andrianto

Salsabilla

et al. 2023

Preprint

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Background: Indonesia, the world's largest archipelago and fourth most populous nation, has limited transportation due to geographical obstacles. This affects the provision of acute time-dependent therapy such as Percutaneous Coronary Intervention (PCI). Indonesia's ageing population, which will increase Acute Coronary Syndrome prevalence in the next decade, will worsen this problem. Therefore, the analysis and enhancement of cardiovascular care are crucial. The catheterization laboratory (cath lab) performs PCI procedures. This study maps the number and distribution of Indonesia's cath lab facilities. Methods: A direct survey was used to collect cath lab location data. Population data came from the Ministry of Home Affairs. The growth of cath labs is shown and analyzed by region. The ratio and the Gini index are the primary comparison tools between regions and over time. Findings: The number of cath labs in Indonesia significantly increased from 181 to 310 in the last five years, with 44 of the 119 new labs built in an area that did not have one. Java has the most cath labs (208 cath labs, 67%). The cath lab ratio in the provinces of Indonesia ranges from 0.0 in West Papua and Maluku to 4.46 in Jakarta; the median is 1.09. (IQR 0.71-1.18). The distribution remains a problem, as shown by the high cath lab Gini index (0.48). Interpretation The number of cath labs in Indonesia has increased significantly in recent years. However, maldistribution remains a concern. in order to improve Indonesia's cardiovascular emergency services, Future cath lab development must be planned better by considering the facility accessibility and density. Funding: The study was conducted with the researcher's funds

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The 30 Years of Shifting in The Indonesian Cardiovascular Burden—Analysis of The Global Burden of Disease Study

Muharram,

Multazam,

Mustofa

et al. 2024

J Epidemiol Glob Health

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Importance Cardiovascular disease (CVD) remains the leading cause of mortality and morbidity. Compared with disease burden rates in 1990, significant reductions in Disability-Adjusted Life Years (DALYs) burden rates for CVD have been recorded. However, general DALYs rates have not changed in Indonesia in the past 30 years. Thus, assessing Indonesian CVD burdens will be an essential first step in determining primary disease interventions. Objective To determine the national and province-level burden of CVD from 1990 to 2019 in Indonesia. Design, Setting, and Participants A retrospective observational study was conducted using data from the Global Burden of Disease (GBD) 2019, provided by the Institute of Health Metrics and Evaluation (IHME), to analyze trends in the burden of CVD, including mortality, morbidity, and prevalence characteristics of 12 underlying CVDs. Exposures Residence in Indonesia. Main Outcomes and Measures Mortality, incidence, prevalence, death, and DALYs of CVD. Results CVD deaths have doubled from 278 million in 1990 to 651 million in 2019. All CVDs recorded increased death rates, except for rheumatic heart disease (RHD) (− 69%) and congenital heart disease (CHD) (− 37%). Based on underlying diseases, stroke and ischemic heart disease (IHD) are still the leading causes of mortality and morbidity in Indonesia, whereas stroke and peripheral artery disease (PAD) are the most prevalent CVDs. Indonesia has the second worst CVD DALYs rates compared to ASEAN countries after Laos. At provincial levels, the highest CVD DALY rates were recorded in Bangka Belitung, South Kalimantan, and Yogyakarta. In terms of DALYs rate changes, they were recorded in West Nusa Tenggara (24%), South Kalimantan (18%), and Central Java (11%). Regarding sex, only RHD, and PAD burdens were dominated by females. Conclusions CVD mortality, morbidity, and prevalence rates increased in Indonesia from 1990 to 2019, especially for stroke and ischemic heart disease. The burden is exceptionally high, even when compared to other Southeast Asian countries and the global downward trend. GBD has many limitations. However, these data could provide policymakers with a broad view of CVD conditions in Indonesia.

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Clinical Cardiology in South East Asia: Indonesian Lessons from the Present towards Improvement

Cited by 12 publications

References 50 publications

Dilemmas in pregnancies with pulmonary hypertension: Case report from a low-resource setting

Dilemmas in pregnancies with pulmonary hypertension: Case report from a low-resource setting

Catheter Laboratory Facilities in Indonesia: Number, Growth, and Distribution in The Largest Archipelago Nation

The 30 Years of Shifting in The Indonesian Cardiovascular Burden—Analysis of The Global Burden of Disease Study

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