TANTANGAN PENYAKIT

JANTUNG KORONER
DI INDONESIA

Anna Ulfah Rahajoe

Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI)
Indonesian Heart Association (IHA)
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PENYAKIT TIDAK MENULAR PENYEBAB

KEMATIAN TERBESAR
10%
60 million

Total number of deaths in the world

5.8 M

50 million

40 million

26.0 M
( above the age of 60 )

30 million

9.0 M

20 million

( below the age of 60 )

10 million

18.0 M

(60% of all deaths)

CVDs,
Cancer
Chr Resp Dis
DM

0 million

Low-income countries

Group III - Injuries

Group II Other deaths from noncommunicable diseases (NCD)
Group II Premature deaths from NCD (< 60yrs) which are preventable
Group I Communicable diseases, maternal, perinatal and nutritional conditions

Deaths worldwide: 1990-2020

Reported in 1990
50 million deaths worldwide from any cause
11 million in developed countries
39 million in developing countries

Predicted for 2020

68 million deaths worldwide from any cause
14 million in developed countries
54 million in developing countries (79,4%)

Global Burden of Disease Study, 1996

Deaths from CVD Worldwide: 1990-2020

Reported in 1990
14 million deaths worldwide (28%)
5 million in developed countries
9 million in developing countries

Predicted for 2020

25 million deaths worldwide (37%)
6 million in developed countries
19 million in developing countries
Global Burden of Disease Study, 1996

Indonesia 237.6 M population

- 33 Provinces,
- 505 districts/towns

+ 52%
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Penyebab Kematian di Indonesia

Causes of Death

Causes of Death

Stroke
Tuberculosis
Hypertension
Injury
Perinatal/maternal
Diabetes Mellitus
Neoplasm/cancer
Liver disease
Ischemic Heart Dis.
Lower resp. tract dis.
Heart disease

15,4
7,5
6,8
6,5
6,0
5,7
5,7
5,1
5,1
5,1
4,6

Pneumonia
Diarrhea
Gastric ulcer
Typhoid
Malaria
Meningitis/Encephalitis
Congenital malform
Dengue
Tetanus
Septicemia
Malnutrition

3,8
3,5
1,7
1,6
1,3
0,8
0,6
0,5
0,5
0,3
0,2

Sumber : RISKESDAS, 2007

CVD & DM = 37.6%

Penyebab Kematian, semua umur di Indonesia

1995, 2001, 2007
59.5

60

49.9

50

44.2

41.7

NCDs meningkat
+ 19% /6 yrs
+ 31% /10 yrs

40

31.2
28.1

30

Africa + 27%
E. Mediterranean + 25%

20
10

10.1
6

5.9

7.3

6.5
HHS 1995
HHS 2001

0
Maternal and
Perinatal
conditions

Communicable Noncommunicable
Disease
Disease

Injury

BHR 2007

HHS=Household Health Survey

BHR =Basic Health Research

Healthy life years lost to CVD

50
India

40

China

30

Africa
Middle East

20

South America
Other Asia

10
0

1990

2000

2010

2020
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PREVALENSI NCDs
NCDs cases
Hypertension
Stroke
Heart disease
Arthritis
Land traffic injuries
Asthma
DM
DM (urban population)
Tumor / cancer

%
31.7
8.3
7.2
30.3
25,9
3.5
1.1
5.7
4.3

Source: BHR, 2007

*>10 year old; #>15 year old; ** 15 year old (BHR, 2010)

HYPERTENSION : PREVALENCE & COVERAGE

NO

NO

HYPERTENSION

BHR 2004

DIAGNOSED OR UNDER TREATMENT

10

Coverage : Proportion patients diagnosed or under medical treatment

Cardiovascular Risk Factors

Risk factors
Everyday servings salty foods
Everyday servingd fatty foods
< 5 servings of fruits & vegetables
Lack of physical activity
Smokers
Overweight & obese
Emotional-mental disorder
Alcohol use

%
24.5*
12.8*
93.6*
48.2*
34,7**
19.1#
11.6#
4.6*

Source: BHR, 2007

*>10 year old; #>15 year old; ** 15 year old (BHR, 2010)

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80% of smokers live in the developing countries

Tobacco caused 5.4 million deaths in the world
(1 death every 6.5 seconds)

Indonesia :
300,000 deaths each year due to tobacco
INDONESIAN SMOKERS
Smoking Prevalence (>15 Th)
Male Smokers (>15 Th)
Women (>15 Th)
Population exposed to
cigarette smoke

BHR
2007
33,4%

BHR
2010
34,7%

65,3%
5,06%
84,5 %

65,9%
4,2%
76,1%
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Teenage Trend smoking prevalence

The prevalence of teenage smokers according to age
group 15-19 years, by sex - in Indonesia,
37.3

40

32.8

35
30

24.2

25
20
15

18.8

12.7

10
5

17.3

13.7
7.1
0.3

0.2

Laki
Male
Perempuan
Female
Total

1.9

1.6

0
1995

2001

2004

2007

Source: Susenas (1995, 2001, 2004) dan BHR 2007

Global Youth Tobacco Survey in Indonesia (2007)

20,3 % junior high school student smokes

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NCDs PREVENTION AND CONTROL

Proven cost effective
High-level commitment & concrete action missing
Under-funded
Not mentioned in Millenium Development Goals

INDONESIAN ACTION PLAN

ON NCDs PREVENTION & CONTROL
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Patient

ACS patients at the NCVC Emergency Unit

10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0

8060

1499
(18,6%)

2005

8306

1678
(20,2%)

2006

8661

9634

8007

1882
(23,5%)

2007

Year
Total patient admitted to ER

2332
(30,4%)

2008

3402
(35%)

3402

2009

Number of ACS patient

Source: JAC registry data base 2010, NCCHK

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NATIONAL CARDIOVASCULAR CENTER

REGISTRY ON ACUTE CORONARY SYNDROME
(N = 2797 patients)
Risk factors in ACS patients (all age)
Hypertension
Hypercholesterol
Active smoker

66%
45%
33%

ACS patients ( < 40 years ) 3.8%

Active smoker
Ex smoker
Hypertension
Hypercholesterol

55%
12%
44%
40%
16

ACS registrys patient distribution

Consecutive ACS
N=2103

No reperfusion
N= 379 (59%)

STEMI
N= 654 (31.1%)

NSTEMI
N= 622 (29.6%)

Fibrinolytic
N= 81 (12%)

Primary PCI
N= 194 (29%)

UAP
N= 827 (39.3%)

Source: JAC registry data base 2010, NCCHK

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PRIMARY PCI in ACS vs Total PCI

PCI

PPCI
N

Year

Source: JAC registry data base 2010, NCCHK

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Changes in

in-hospital mortality of ACS

%

6.6%

5.3%

4.1%

th. 2007
th. 2008

th. 2009

2
1
0
th. 2007

th. 2008

th. 2009

Source: JAC registry data base 2010, NCCHK

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POPULATION DISTRIBUTION AND

TERTIARY CARDIOVASCULAR SERVICES
4
12

3
6

Padang
5

3
Samarinda

2
9

3.5

Bengkulu 2

2
2

11

11

30

36
- RSJPD HK
- RSCM
- RSHS - Bdg

40

3
RS Dr.S
RS SA - Malang

8.870 PHC, 23.163 sub-centers, 1.556 hospitals, 500 Cardiologist

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AGE STANDARDIZED MORTALITY CAUSE BY

ISCHEMIC HEART DISEASE/100.000 INHIBITORS

10 more cardiology & vascular medicine dept. was

appointed as an education center
IHA target : 1000 cardiologist in 2020
UN data 2008

21
4

Top referal &

Quartenery care
Tertiary
CV. Care

Secondary
CV Care

Primary CV Care
Basic Health Care

Public Health & Self Health Care

(Community Based)

INDONESIAN NCVC

INTEGRATED CV SERVICE
IN PROVINCE HOSPITAL
(TYPE A & B)
CV SERVICE IN
DISTRICT HOSPITAL
(TYPE C & D)
PRIVATE PRACTICE
PUBLIC HEALTH CARE
NGO IHF etc.
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KESIMPULAN :
CVDs penyebab kematian utama di Indonesia

Kematian akibat CVD di negara berkembang >>

Dampak ekonomi CVDs : GDP menurun, cost naik
Epidemi CVDs meningkatkan kemiskinan
Perlu koordinasi & kolaborasi : pemerintah, profesi
medis, LSM, sektor privat & media
Parlemen : naikkan anggaran kesehatan!
Kemenkes: naikkan biaya promosi prevensi &
pengendalian CVD
Plan of action yng terintegrasi : tobacco control,
penerangan diet sehat, OR, bahaya alcohol
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KESIMPULAN :
Paket efektif prevensi & pengendalian CVDs
Perkuat Primary Health Care Dr. KELUARGA
- melaksanakan prevention and control
- deteksi dini & terapi emergensi
- melakukan surveillance dampak intervensi

Bentuk penyuluh kesehatan CVDs yg tangguh unt:

- melaksanakan prevention and control
- melakukan surveillance dampak intervensi
Meningkatkan Riset prevensi & control CVDs
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THANK YOU
FOR YOUR ATTENTION

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