Risk Factors for Rheumatic Cardiac Disease ( RCD )

In Elderly Outpatients at Langsa District HospitalRisk Factors for

Rheumatic Cardiac Disease (RCD) In Elderly Outpatients at Langsa
District Hospital

Said Usman1, Aris Winandar 22. And Ibrahim Champion 2

1
Medicine Faculty, Syiah Kuala University, Banda Aceh 23245, Indonesia
2
Department of Epidemiology,Faculty of Public Health, Serambi Mekah University, Banda Aceh 23245, Indonesia
3
Department of Epidemiology, Serambi Mekah University, Banda Aceh 23245, Indonesia

Correspondence should be addressed to Said Usman; saidusman@unsyiah.ac.id

Keywords: Rheumatic Cardiac Diseases,Elderly Outpatients

Abstrack:

Rheumatic Cardiac Diseases (RCD) are disorders of the heart and the coronary arteries that occur with
blood vessel walls thickening and luminal narrowing of atherosclerotic coronary arteries that disrupt
blood flows to the heart muscles, causing damage and impaired function of the heart muscles. The
purpose of this study was to identify risk factors for precipitating RCD events amongst elderly outpatient
at Langsa District Hospital in 2016.

This research was a case study analysis of risk factors for RCD using a case-control design: Consecutive
sampling was used to get a sample of 74 elderly out-patients with RCD and Accidental sampling was used
to get 74 control elderly out-patients that were non-RCD from out-patients going for treatment to Langsa
District Hospital’s polyclinic. Data analysis included bivariate analysis using the chi-square test and
multivariatee analysis using multiple logistic regression. The results of this research showed that there
were significant relationships between smoking, hypertension, obesity and diabetes with RCD in elderly
out-patients whilst the most significant factor in the incidence of RCD was hypertension.

1

1. INTRODUCTION
1.1. Background. One group of not- contagious
diseases (NCD) that concerns people at present are
heart diseases and blocked arteries.
Based on 2005 WHO reports, from 58 million deaths
world-wide, 17.5 million (30%) were due to heart
disease and blocked arteries, primarily heart attacks
(7.6 million) and strokes (5.7 million). In 2015 deaths
due to heart disease (cardiovascular diseases) and
blocked arteries in Indonesia will increase to more
than 20 million (Indonesian Health Dept.
{Depkes}2009).
Heart disease still remains the primary cause of
morbidity (serious life threatening diseases) and
death of adults in Europe and north America. Each
year, in the USA, nearly 500,000 people die from
ischemic heart disease. In Asia and Africa, there is
an increasing prevalence of heart disease and death
from heart disease. In Singapore and Malaysia the
rate has increased from a level where they were of
little concern to 10% of all deaths (Remond MG
Mukhtiaranti, et al, 201312).
In Indonesia, in 2013, based on data from the
Health Department’s Basic Health Research unit,
according to diagnoses from doctors, the Province
with the highest rate of coronary heart disease in
people 15 years old and over was Nusa Tenggara
Timur (4.4%). This was followed by Central
Sulawesi (3.8%) and South Sulawesi (2,9%). Whilst
the provinces with the lowest prevalence were Riau
(0,3%), Lampung (0,4%), and Jambi (0,5%).
Heart disease can come from problems in the
arteries due to narrowing or blockages which disturb
the transportation of materials for energy to the body
so that there is an imbalance between the need for
oxygen and the supply of oxygen. This imbalance
results in disturbance to the pumping (of blood) by
the heart which eventually causes weakness and
death of cells in the heart. Heart diseases are a group
of cardiovascular diseases which are now becoming
a world–wide threat. The September 2009 report
from the WHO said that heart disease now appears
to be the prime cause of death (Yahya, 2010 in Mira,
2012).
The prevalence of Rheumatic Cardiac Disease
(RCD) in Indonesia according to symptoms, based
on interviews, increases with age, the highest
incidence was 2.0% (females) and 3.6% (males) in
the age range 65-74 and then it decreased slightly in
the 75 and over group. The prevalence of RCD
when diagnosed by a doctor or when diagnosed by a
doctor or by symptoms was higher amongst women
(0,5% and 1,5%). Rheumatic Cardiac Disease
(RCD) was more prevalent amongst those who had
no schooling and did not work. Based on diagnosis
by a doctor Rheumatic Cardiac Disease (RCD) was
more prevalent in cities , however based on doctors’
2
diagnosis and symptoms it was more prevalent in rural
areas and in the lowest (income) quintile (Riskesdas,
2013).
Based on previous diagnosis by a doctor, the
prevalence of RCD in Indonesia was 0.5% and based on
a doctors’ diagnosis or symptoms it was 1.5%. The
prevalence of a heart attack based on previous doctors’
diagnosis was 0.13% in Indonesia and based on a
doctors’ diagnosis or symptoms was 0.3%. The
prevalence of a stroke in Indonesia based on the
diagnosis of a health worker was 7.0 ‰ (per mil) and
based on a health workers’ diagnosis or symptoms was
12.1 ‰ (per mil). Thus, 57.9% of strokes have been
diagnosed by health workers. The prevalence of RCD,
heart attacks and strokes increases with increase in age
and the prevalence of strokes is the same for both sexes.
(Riskesdas, 2013).
The increasing number of elderly (in the population)
needs to be handled seriously because due to natural
causes, increasing age brings with it declines in physical
health, both biologically and mentally and this cannot be
be separated from economic, social and cultural factors
so it needs an effort by families and by society to handle
it.
The decline in functions of various organs amongst
the elderly makes them liable to diseases which are acute
or chronic. There is an increased tendency to suffer from
diseases which are degenerative, metabolic, infectious
and/or which cause psychosocial disturbance (Nugroho,
2000. Dalam Eko Setiawan).
Increases in the general health of people will
be accompanied by an increase in life-expectancy in
Indonesia. Based on the 2011 UN Report for Indonesia,
in 2000-2005 life expectancy was 66 (with the total of
elderly in 2000 being 8%), this figure has been projected
to increase so that in 2045-2050 life-expectancy
will be 77 (with the elderly, in 2045, being
29% of the total population).
So too in Indonesia, according to the National
Statistics Body, there has been an increase in life-
expectancy. In 2000 it was 64 (with 7.18% elderly) which
increased to 69 in 2010 (with 7.56% elderly) and
increased again in 2011 to 70 (with 7.58% elderly (Rizky,
2012).
Research done by Mira Rosmiatin to analyse the risk
factors relative to RCD amongst 136 elderly women
patients at the Dr. Cipto Mangunkusumo Womens’
Hospital in Jakarta with a multi-variant cross-sectional
analysis showed that the most significant factor was age
(OR=3,64), where age was the most significant predictor
of RCD (p<0,001).
Furthermore, research done by Eko Setiawan in 2012
concerning the risk factors for heart attacks amongst
elderly patients at the geriatric diseases unit in the Dr
Kariadi District Hospital in Semarang, Central Java,
showed that there was a significant connection between

dislipidimia and heart attacks with p-value 1.000 and
Odds Ratio (OR) = 1.00 with a Confidence Interval
(CI=95%).
Based on data from the Langsa Health
Department the death rate from non-infectious
diseases in the City of Langsa during the 5 years
from 2010 to 2015 showed an increase. RCD was in
8th place both for deaths and for serious
diseases/morbidity.
In 2010, there were 1.290 cases (2.17%); in 2009
it doubled to 2.548 cases (2.67%); in 2010 a slight
decrease to 2.132 cases (1.45%); then in 2011 the
number increased 67% to 3,485 cases (2.70%) and
again in 2012 there were 3.532 cases (2.52%). Then,
in 2013 a 50% increase to 5.336 cases but the
incidence decreased (2.10%). This shows that the
number of cases coming to the hospital fluctuated.
The main risk factor for the incidence of RCD
amongst out-patients at the Langsa District
Hospital polyclinic in 2016 was being in the
elderly age group.
1.2. Problem
The problem for this research
was what was the influence of the
various risk factors on RCD amongst
elderly out-patients of the Langsa
District Hospital in 2016.
Patients in the age group(s) at
risk with a risk of RCD are advised to
straight away steps to avoid it by
engaging in physical activity and
adopting a healthy life style and taking
care of the values in their lipid profile
in their blood, one way is to routinely
check their blood pressure to avoid
complications like RCD.
1.3.Research Question
Based on the background
above, the problem to be studied in this
research was: What were the effects of
the various risk factors for RCD
amongst elderly out-patients of Langsa
District Hospital in 2016?
.
1.4. Research Objective
To understand what were the
risk factors that could set off RCD
3
amongst elderly out-patients at Langsa
District Hospital (LDH) in 2016.
1. To understand the risk from smoking
related to RCD in elderly out-patients of
LDH in 2016.
2. To understand the risk from hyper-
tension related to RCD in elderly out-
patients of LDH in 2016.
3. To understand the risk from obesity
related to RCD in elderly out-patients of
LDH in 2016.
4. To understand the risk from Physical
inactivity related to RCD in elderly out-
patients of LDH in 2016.
5. To understand the risk from Diabetes
mellitus related to RCD in elderly out-
patients of LDH in 2016.
6. To understand the attributes of the
population at risk of getting RCD
amongst elderly out-patients of Langsa
District Hospital in 2016.
.1.5. Hypotheses:
a) Smoking was a risk factor that was
linked to Rheumatic Cardiac Disease
(RCD) amongst elderly out-patients
at Langsa District Hospital (LDH) in
2016.
b) High blood pressure was a risk factor
that was linked to RCD amongst
elderly out-patients at LDH in 2016.
c) Obesity was a risk factor that was
linked to RCD amongst elderly out-
patients at LDH in 2016.
d) Lack of physical activity was a risk
factor that was linked to RCD
amongst elderly out-patients at LDH
in 2016.
e) Diabetes mellitus was a risk factor that
was linked to RCD amongst elderly
out-patients at LDH in 2016.
2.
2.RESEARCH METHODS
Research Methods
2.1 Type of Research

This study was an analytical research program
with a case control design that started with
identifying subjects/patients with the research
condition (the test group) and also persons/
successive patients without the research condition
(the control group) which met the criteria for the
study.
2.2 Population and Research Samples
The population for this study were all the elderly
patients who attended the Langsa District Hospital
(LDH), Aceh in 2016. These were divided into the
Study Group and the Control Group.
1) The Study Population were elderly (over 60
years of age) patients who attended the
polyclinic who were diagnosed with RCD by
the LDH doctors in 2016. 3)
2)
3) The Control Population were elderly (over
60) patients who attended the LDH polyclinic
who were not suffering from RCD in 2016.
4)
5) The Study Sample were some of the elderly
(over 60) patients who attended the
polyclinic who were diagnosed with RCD
by the LDH doctors in 2016.
6)
7) The Control Sample were successive elderly
(over 60) patients who attended the LDH
polyclinic who were not suffering from RCD
in 2016 and who agreed to be interviewed.
Based on calculations, the minimum sample size
must be 74 people with a ratio of 1: 1 between the
Study Sample and the Control Sample.
The Study Sample was gathered using the
Consecutive sampling technique whereby the sample
was gathered by chance as candidates that met the
sampling criteria came forward until the total
number required was met (Q. Ashton,
2011Notoatmodjo, 2010).
The Control Sample was gathered using
Accidental sampling whereby candidates that met
the specified criteria to be controls for the study
were accumulated until the total number required
had been gathered (Q. Ashton, 2011Notoatmodjo,
ibid).
The criteria for inclusion in the study sample
was all successive elderly (over 60) out-patients who
went to the LDH polyclinic who were suffering from
Rheumatic Cardiac Diseases (RCD) who agreed to
be interviewed until the minimum sample size (74)
was reached: And the criteria for inclusion in the
control was all successive elderly (over 60) out-
patients who went to the LDH polyclinic who were
not suffering from RCD who agreed to be
interviewed until the minimum sample size (74)
was reached.
4
The criteria for exclusion was all patients as
above who did not agree to be interviewed and/or be
monitored and/or to have their blood pressure measured.
2.3.Data Analysis
After the data had been gathered it was analyzed as
follows:
1) Univariant Analysis
2)
This was done to look at the frequency distribution of the
results for each variable to see whether the results looked
valid using the SPSS program.
2). Bivariant Analysis was used to test the hypothesis
between each dependent variable and the independent
variable.
The statistical test used was the Chi Squared test with a
95% confidence interval, with α = 0.05. This test was to
determine whether Ho was rejected or accepted with
the criteria that if p-value < 0.05 Ho was rejected
meaning that there was a significant relationship and if
p- >0.05 then Ho was accepted meaning that there was
no significant relationship between the two variable
Multivariant Analysis was done to test the relationships
between several independent variables and one
dependent variable (Hastono, 2007).
3. RESULTS AND DISCUSSIONS
3.1 Incidence of Independent Variables
Based on table 1, 47 (64%) of those with RCD
were smokers and 27 (36%) of the non-RCD patients
were smokers, 41 patients (55%) who had RCD were
physically inactive whilst 23 patients (45%) who did
not have RCD were physically inactive, 45 patients
(61%) who had RCD were also suffering from diabetes
mellitus whilst 29 patients (39%) who did not have
RCD had diabetes mellitus, 57 patients (77%) who had
RCD also had high blood pressure whilst 17 patients
(23%) who did not have RCD had high blood pressure,
42 patients (57%) who had RCD were also obese whilst
32 patients (43%) who did not have RCD were obese.
Multivariant analysis looked at the relationships
between the independent variables with the one dependent
variable at the same time in order to find out which
independent variable had the most influence on the
dependent variable and whether the effect of any one
independent variable on the dependent variable was
affected by any other variables or not (Hastono, 2007).
 5

5) (e). Based on the data in table 2, concerning the

Table 1. Incidence of Variables
3. RESULTS AND DISCUSSIONS
3.1 Incidence of Independent Variables
1) (a) Based on table 1, 47 (64%) of those with
RCD were smokers and 27 (36%) of the non-
RCD patients were smokers.
possibility of a link between obesity and RCD, the
value of p = 0.005. This indicates that there was a
link between being obese and RCD (p<0,05)..
From the risk factor analysis the value of OR =
2.734. This means that the RCD sample were
2.734 times more likely to be obese than the non-
RCD sample.
3.3 Multivariate Analysis

2) (b). 41 patients (55%) who had RCD were The variables which had already been examined
physically inactive whilst 23 patients (45%) by bivaraiate analysis were next examined by
who did not have RCD were physically multivariate analysis using logical pairing regression
inactive. analysis with the Backward Likelihood Ratio method.

3) (c) 45 patients (61%) who had RCD were also Table 3: Results of Multivariant Analysis of
suffering from diabetes mellitus whilst 29
Candidate Patients.
patients (39%) who did not have RCD had
diabetes mellitus Variable p Value
Smoking 0,009
4) 57 patients (77%) who had RCD also had high
blood pressure whilst 17 patients (23%) who Obesity 0,003
did not have RCD had high blood pressure. Physically Active 0,003
5) 42 patients (57%) who had RCD were also Hypertension 0,001
obese whilst 32 patients (43%) who did not Diabetes Mellitus 0,001
have RCD were obese.
Table 1. Incidence of Variables
3.4. Results of Multivariant Analysis
Risk Factors
1) Based on the data in table 2 that follows, After doing the selection of candidates for
multivariant analysis the multivariant tests were done to
concerning the possibility of a link between
smoking and RCD, the value of p =0.021. create the multivariant model.
This indicates that there was a link between
smoking and RCD. From the risk factor
analysis the value of OR = 2.285. This means
that the RCD sample were 2.285 times more
likely to smoke than the non-RCD sample.
2) (b) Based on the data in table 2, concerning
the possibility of a link between physical
inactivity and RCD, the value of p = 0.032.
This indicates that there was a link between
physical inactivity and RCD (p<0,05). From
the risk factor analysis the value of OR =
2.163. This means that the RCD sample were
2.163 times more likely to be inactive than
the non-RCD sample.
3) (c). Based on the data in table 2, concerning
the possibility of a link between diabetes
mellitus and RCD, the value of p = 0.002.
This indicates that there was a link between
diabetes mellitus and RCD (p<0,05). From
the risk factor analysis the value of OR =
3.041. This means that the RCD sample were
3.041 times more likely to suffer from
diabetes mellitus than the non-RCD sample
4) (d). Based on the data in table 2, concerning
the possibility of a link between hypertension
and RCD, the value of p = 0.001. This
indicates that there was a link between
hypertension and RCD (p < 0.05).. From the
risk factor analysis the value of OR = 3.353.
This means that the RCD sample were 3.353
times more likely to have hypertension than
the non-RCD sample.
 6

No 33 45 47 64
Diabetes
Mellitus
Variable RCD Non RCD
Yes 45 61 25 33
(n=74) (n=74)
No 29 39 49 67
n % n %
Hypertens
Smoking
ion
Formerly 47 64 32 43 Yes 57 77 37 50
Not 27 36 42 57 No 17 23 37 50
Physical Obesity
inactivity Yes 42 57 24 32
Yes 41 55 27 36 No 32 43 50 68
7
 8

Table 2. Effect of Risk Factors on incidence of RCD amongst Samples with RCD and without RCD
at Langsa District Hospital in 2016

(2n=148)
RCD Non RCD X2 OR
p Value
Variable (n=74) (n=74) 95% CI
n % n %

Smoker
Yes 47 60 32 41 2.285
6.109 0.021
No 27 39 42 61 (1.181-4.420)
Inactive
Yes 41 60 27 40 2.163
5.332 0.032
No 33 41 47 59 (1.119-4,180)
DM
Yes 45 64 25 36 3,041
9.785 0.002
No 29 37 49 63 (1,555-5,948)
Hypertension
Yes 57 61 37 39 3,353
10.526 0.001
No 17 32 37 68 (1,652-6,805)
Obesity
Yes 42 64 24 35 2,734
7.903 0.005
No 32 39 50 61 (1,400-5,342)

Non RCD OR 95%

Variable RCD (n=74) X2 p Value
(n=74) CI
n % n %
Smoker
2.285
Yes 47 60 32 41 6.109 0.021
(1.181-4.420)
No 27 39 42 61
Inactive
2.163
Yes 41 60 27 40 5.332 0.032
(1.119-4,180)
No 33 41 47 59
DM
3,041
Yes 45 64 25 36 9.785 0.002
(1,555-5,948)
No 29 37 49 63
Hypertensio
n
3,353
Yes 57 61 37 39 10.526 0.001
(1,652-6,805)
No 17 32 37 68
Obesity
2,734
Yes 42 64 24 35 7.903 0.005
(1,400-5,342)
No 32 39 50 61

Table 4. Multivariant Analysis

Inactive .831 .392 4.486 1 .034 2

DM 1.229 .404 9.240 1 .002 3
B S.E Wald Df
Hypertension 1.350 .428 9.950 1 .002 3
Obesity 1.216 .404 9.067 1 .003 3
Smoking .891 .408 4.773 1
Constant 8.188 1.507 29.517 1 .000 .

3.2 Risk Factors


Based on the data in table 2 that follows,
concerning the possibility of a link between
smoking and RCD, the value of p =0.021. This
indicates that there was a link between smoking
and RCD. From the risk factor analysis the value
of OR = 2.285. This means that the RCD sample
were 2.285 times more likely to smoke than the
non-RCD sample, concerning the possibility of a
link between physical inactivity and RCD, the
value of p = 0.032. This indicates that there was a
link between physical inactivity and RCD
(p<0,05). From the risk factor analysis the value of
OR = 2.163. This means that the RCD sample were
2.163 times more likely to be inactive than the
non-RCD sample, concerning the possibility of a
link between diabetes mellitus and RCD, the value
of p = 0.002. This indicates that there was a link
between diabetes mellitus and RCD (p<0,05).
From the risk factor analysis the value of OR =
3.041. This means that the RCD sample were
3.041 times more likely to suffer from diabetes
mellitus than the non-RCD sample, concerning the
possibility of a link between hypertension and
RCD, the value of p = 0.001. This indicates that
there was a link between hypertension and RCD (p
< 0.05).. From the risk factor analysis the value of
OR = 3.353. This means that the RCD sample were
3.353 times more likely to have hypertension than
the non-RCD sample, concerning the possibility of
a link between obesity and RCD, the value of p =
0.005. This indicates that there was a link between
being obese and RCD (p<0,05).. From the risk
factor analysis the value of OR = 2.734. This
means that the RCD sample were 2.734 times more
likely to be obese than the non-RCD sample.
Based on the data in table 4 the variable with
the most influence on the dependent variable can
be seen from the significance of the exponent (B),
the larger the value of (B) means the bigger the
influence on the variable being analyzed. Based on
the analysis, the variable with the most influence
on RCD was hypertension ie high blood pressure.
Elderly patients with RCD due to the risk
factors of smoking, physically inactive, DM and/or
obesity were 39% more likely to suffer from
hypertension than patients who did not have
RCD.
Based on the Odds Ratio (OR) the strength of
each variable – smoking, obesity, physical
inactivity, DM and hypertension on the incidence
of RCD amongst the elderly, can be seen. The
bigger the value of the OR the stronger the effect
of the variable concerned on the incidence of RCD.
How large a population could be saved from
RCD if the risk from hypertension can be managed
can be seen from the Population Attributable Risk
(PAR) in this research.
The variable with the most influence on the
dependent variable can be seen from the
significance of the exponent (B), the larger the
value of (B) the bigger the influence on the
variable being analyzed. Based on the analysis, the
variable with the most influence on RCD was
9
hypertension ie. high blood pressure (Exp B =
3,858).
Next the Model assumes from multiple
regression analysis for the probability of a disease
occurring using the formula and calculations as
follows:
1+e -
(α+β1X1+β2X2+β3X3……
F(Z) = 1+e - (α+β1X1+β2X2+β3X3………+βiXi)
=1+e - 1
(α+β1X1+β2X2+β3X3 1+e - (8+0,029+0,034+0,002+0,002+0,003)
= 39 %
From the foregoing it can be seen that
elderly out-patients with RCD with the risk factors
of smoking, obesity, inactivity and/or DM are 39%
more likely to have hypertension than those not
suffering from RCD.
p (r - 1)
PAR =
p (r - 1)+ 1
= 0,606 (3,353)
=
67 % 0,606 (3,353) + 1
= 67%
Based on the calculations above, the value of the
Population Attribute Risk (PAR) is 67% which is the
amount that the incidence of RCD amongst the
elderly could be reduced if their hypertension could
be controlled.
3.3 Multivariant Analysis
After doing the selection of candidates for
multivariant analysis the multivariant tests were
done to create the multivariant model.
The variable with the most influence on the
dependent variable can be seen from the
significance of the exponent (B), the larger the value
of (B) means the bigger the influence on the variable
being analyzed. Based on the analysis, the variable
with the most influence on RCD was hypertension
ie high blood pressure.
Elderly patients with RCD due to the risk factors
of smoking, physically inactive, DM and/or obesity
were 39% more likely to suffer from hypertension
than patients who did not have RCD.
Based on the Odds Ratio (OR) the strength of
each variable – smoking, obesity, physical inactivity,
DM and hypertension on the incidence of RCD
amongst the elderly, can be seen. The bigger the
value of the OR the stronger the effect of the
variable concerned on the incidence of RCD.
How large a population could be saved from
RCD if the risk from hypertension can be managed
can be seen from the Population Attributable Risk
(PAR) in this research.
The variable with the most influence on the
dependent variable can be seen from the
 10

significance of the exponent (B), the larger the value People in the age group at risk, who have a high
of (B) the bigger the influence on the variable being risk of coronary heart diseases (RCD), are advised
analyzed. Based on the analysis, the variable with to take steps to prevent it by engaging in physical
the most influence on RCD was hypertension high activities and adapting a healthy lifestyle and
blood pressure (Exp B = 3,858). especially watch the lipid profile of their blood, in
Next the Model assumes from multiple particular routinely control their blood pressure to
regression analysis for the probability of a disease avoid complications like RCD.
occurring using the formula and calculations as Langsa District Hospital (LDH) must make
follows: efforts to inform patients and visitors to Langsa DH
about the risk factors associated with RCD,
hopefully this will be done continuously both by the
F(Z) = 1+e - (α+β1X1+β2X2+β3X3………+βiXi)
1 government and by other associated parties in order
1+e - (8+0,029+0,034+0,002+0,002+0,003) to reduce the incidence of RCD which are one group
= of diseases with a high risk of mortality.
= 39 %
REFERENCES
From the foregoing it can be seen that elderly
out-patients with RCD with the risk factors of Acton, Q. Ashton, PhD. 2011. Antiseptic and
smoking, obesity, inactivity and/or DM are 39% Germicides : Advances in Researchand
more likely to have hypertension than those not Application. Scholarly Editions: Atlanta.
suffering from RCD. Remond MG, Severin KL, Hodder Y, Martin J,
p (r - 1) Nelson C, Atkinson D, Maguire GP. Variability
PAR = in disease burden and management of
p (r - 1)+ 1
rheumatic fever and rheumatic heart disease in
= 0,606 (3,353 two regions of tropical Australia. Intern Med
0,606 (3,353) + 1 J. 2013;43:386–393.
= 2.031 Depkes RI. 2009. Profil Kesehatan Indonesia;
2.031 + 1 Jakarta, Depkes RI (Indonesian Dept. of
= 67 % Health)
Hastono Sutarito Priyo.2007. Analisis Data
Based on the calculations above, the value of the Kesehatan. FKM UI
Population Attribute Risk (PAR) is 67% which is the Jeini Ester Nelwan, 2011. Karakteristik individu
amount that the incidence of RCD amongst the penderita penyakit jantung koroner di Sulawesi
elderly could be reduced if their hypertension could Utara tahun 2011
be controlled. Mira Rosmiatin, 2012. Analisis factor-faktor risiko
The variables which had already been examined terhadap kejadian penyakit jantung koroner
by bivaraiate analysis were next examined by pada wanita lanjut usia di RSUPN Dr.Cipto
multivariate analysis using logical pairing regression Mangunkusumo Jakarta.(Thesis)
analysis with the Backward Likelihood Ratio Mukhtiaranti 2012, Gambaran faktor risiko pada
method. pasien RCD di Rumah Sakit Hasan Sadikin
Bandung periode Januari 2011 – Desember
No Variable p Value
2011 (Thesis )
1 Smoking 0,009
2 Obesity 0,003
3 Physically Active 0,003
4 Hypertension 0,001
5 Diabetes Mellitus 0,001

4. CONCLUSIONS

Rheumatic Cardiac Disease (RCD) is the heart

disease as a result of sequelae (sequelae) from
rheumatic fever (DR) which is characterized by the
occurrence of heart valve defects. The conclusions
from the results of this research based on the
foregoing discussions are as follows, there was a all
research variables in terms of risk factors have an
influence on RCD, and The risk factor with the most
influence on RCD was hypertension/high blood
pressure.
 The variable with the most influence on the
dependent variable can be seen from the significance
of the exponent (B), the larger the value of (B) means
the bigger the influence on the variable being
analyzed. Based on the analysis, the variable with the
most influence on RCD was hypertension ie high
blood pressure.
Elderly patients with RCD due to the risk
factors of smoking, physically inactive, DM and/or
obesity were 39% more likely to suffer from
hypertension than patients who did not have RCD. .
Based on the Odds Ratio (OR) the strength of
each variable – smoking, obesity, physical inactivity,
DM and hypertension on the incidence of RCD
amongst the elderly, can be seen. The bigger the value
of the OR the stronger the effect of the variable
concerned on the incidence of RCD.
How large a population could be saved from
RCD if the risk from hypertension can be managed
can be seen from the Population Attributable Risk
(PAR) in this research.
The variable with the most influence on the
dependent variable can be seen from the significance
of the exponent (B), the larger the value of (B) the
bigger the influence on the variable being analyzed.
Based on the analysis, the variable with the most
influence on RCD was hypertension ie. high blood
pressure (Exp B = 3,858).
Next the Model assumes from multiple
regression analysis for the probability of a disease
occurring using the formula and calculations as
follows:
- (α+β1X1+β2X2+β3X3………+βiXi)
F(Z) = 1 1+e
1+e - (8+0,029+0,034+0,002+0,002+0,003)
= 1
= 39 %
From the foregoing it can be seen that elderly
out-patients with RCD with the risk factors of
smoking, obesity, inactivity and/or DM are 39% more
likely to have hypertension than those not suffering
from RCD.
p (r - 1)
PAR =
p (r - 1)+ 1
= 0,606 (3,353) = 2.031
= 67 %
0,606 (3,353) + 1 2.031 + 1
Based on the calculations above, the value of
the Population Attribute Risk (PAR) is 67% which is
the amount that the incidence of RCD amongst the
elderly could be reduced if their hypertension could be
controlled.
4. Conclusions and Suggestions
The conclusions from the results of this
research based on the foregoing discussions are as
follows:
1. The influence of the risk factors over the likelihood of
getting RCD was as follows:
a) There was a significant influence from smoking on
RCD amongst elderly outpatients;
b) There was a significant influence from physical
inactivity on RCD amongst elderly outpatients;
c) There was a significant influence from diabetes
mellitus on RCD amongst elderly outpatients;
d) There was a significant influence from hypertension
on RCD amongst elderly outpatients;
e) There was a significant influence from obesity on
RCD amongst elderly outpatient.
2. The risk factor with the most influence on RCD was
hypertension/high blood pressure.
Suggestions
For People:
People in the age group at risk, who have a
high risk of coronary heart diseases (RCD), are
advised to take steps to prevent it by engaging in
physical activities and adapting a healthy lifestyle and
especially watch the lipid profile of their blood, in
particular routinely control their blood pressure to
avoid complications like RCD.
For Langsa District Hospital (LDH):
Make efforts to inform patients and visitors to
Langsa DH about the risk factors associated with
RCD, hopefully this will be done continuously both by
the government and by other associated parties in
order to reduce the incidence of RCD which are one
group of diseases with a high risk of mortality.
For Other Researchers:
Do further research in better ways using a
cohort design to look more closely at the risk factors
for RCD using a larger sample over a longer period.
.
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Depkes RI. 2009. Profil Kesehatan Indonesia;
Jakarta, Depkes RI (Indonesian Dept. of Health)
Hastono, Sutarito Priyo.2007. Analisis Data
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Jeini Ester Nelwan, 2011. Karakteristik
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Sulawesi Utara tahun 2011
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penyakit jantung koroner pada wanita lanjut
usia di RSUPN Dr.Cipto Mangunkusumo
Jakarta.(Thesis)
Mukhtiaranti 2012, Gambaran
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Januari 2011 – Desember 2011 (Thesis )
 Rizki Rahmadani, 2012. Faktor- pasien berobat jalan di poli jantung rumah
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