Tesis

Pengaruh Rehabilitasi Jantung Fase II terhadap Nilai Frailty Pasien Gagal Jantung Kronik Stabil = The Effect of Phase II Cardiac Rehabilitation on Frailty Scores in Patients with Stable Chronic Heart Failure.

Latar Belakang: Frailty merupakan sindrom klinis yang mencerminkan penurunan cadangan fisiologis dan kapasitas adaptif. Prevalensi frailty pada pasien gagal jantung cukup tinggi dan berhubungan dengan peningkatan morbiditas serta mortalitas. Rehabilitasi jantung fase II merupakan intervensi komprehensif nonfarmakologis yang terbukti dapat meningkatkan toleransi latihan dan kualitas hidup. Namun, bukti mengenai pengaruhnya terhadap status frailty pada pasien gagal jantung kronik di Indonesia masih terbatas. Tujuan: Menilai pengaruh program rehabilitasi jantung fase II terhadap status frailty pada pasien gagal jantung kronik stabil. Metode: Penelitian analitik observasional dengan desain pre-post ini melibatkan pasien gagal jantung kronik stabil yang mengikuti program rehabilitasi jantung fase II di Rumah Sakit Cipto Mangunkusumo. Status frailty dinilai sebelum dan sesudah intervensi menggunakan Fried Frailty Phenotype. Program meliputi latihan aerobik dan penguatan yang terstruktur, disertai edukasi dan dukungan psikososial. Analisis statistik dilakukan untuk menilai perubahan skor dan kategori frailty, dengan tingkat signifikansi p < 0.05. Hasil: Setelah menyelesaikan program rehabilitasi, terjadi penurunan bermakna pada skor frailty. Sebagian besar pasien mengalami pergeseran kategori dari frail menjadi pre-frail. Peningkatan paling menonjol tampak pada kecepatan berjalan dan kekuatan otot ekstremitas bawah, yang signifikan secara klinis maupun statistik (p < 0.05). Tidak terdapat kejadian efek samping mayor selama intervensi. Kesimpulan: Rehabilitasi jantung fase II memberikan dampak positif terhadap status frailty pada pasien gagal jantung kronik stabil. Integrasi rehabilitasi jantung dalam penatalaksanaan klinis standar berpotensi meningkatkan kapasitas fungsional dan memperbaiki luaran jangka panjang pada populasi ini.
Kata kunci: gagal jantung, frailty, rehabilitasi jantung fase II, kapasitas fungsional


Background: Frailty is a clinical syndrome reflecting decreased physiological reserves and adaptive capacity. The prevalence of frailty among heart failure patients is high and associated with increased morbidity and mortality. Phase II cardiac rehabilitation is a comprehensive, non-pharmacological intervention that has been shown to improve exercise tolerance and quality of life. However, evidence on its effect on frailty status in Indonesian patients with chronic heart failure remains limited. Objective: To evaluate the effect of a phase II cardiac rehabilitation program on frailty status in patients with stable chronic heart failure. Methods: This observational analytic pre–post study involved patients with stable chronic heart failure who participated in a phase II cardiac rehabilitation program at Cipto Mangunkusumo Hospital. Frailty status was assessed before and after the intervention using the Fried Frailty Phenotype. The program consisted of structured aerobic and strengthening exercises combined with education and psychosocial support. Statistical analyses were conducted to examine changes in frailty scores and categories, with significance set at p < 0.05. Results: After completing the rehabilitation program, there was a significant reduction in frailty scores. Most patients shifted from the frail to the pre-frail category. Improvements were most prominent in walking speed and lower extremity muscle strength, both clinically and statistically significant (p < 0.05). No major adverse events were reported during the intervention. Conclusion: Phase II cardiac rehabilitation has a positive impact on frailty status in patients with stable chronic heart failure. Integrating cardiac rehabilitation into standard clinical management may improve functional capacity and contribute to better long-term outcomes for this population.
Keywords: heart failure, frailty, phase II cardiac rehabilitation, functional capacity