Kelengkapan Terapi Medis Sesuai Pedoman dan Dampaknya terhadap Luaran Terapi pada Pasien Angina Pektoris Tidak Stabil: Penelitian di Rumah Sakit Rujukan Tersier di Indonesia
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Angina pektoris tidak stabil (unstable angina pectoris/UAP) merupakan salah satu penyebab utama rawat inap kardiovaskular dan memerlukan penatalaksanaan farmakologis rawat inap yang kompleks. Variasi dalam kelengkapan farmakoterapi inti fase akut berbasis pedoman dapat memengaruhi luaran terapi rawat inap, termasuk lama rawat inap (length of stay/LOS). Penelitian ini bertujuan untuk mengevaluasi kelengkapan farmakoterapi inti berbasis pedoman serta hubungannya dengan LOS pada pasien UAP yang dirawat inap di rumah sakit rujukan tersier di Indonesia. Penelitian observasional deskriptif dengan desain retrospektif dilakukan menggunakan data sekunder dari rekam medis. Dari 214 pasien rawat inap yang disaring, sebanyak 144 pasien dewasa dengan diagnosis UAP memenuhi kriteria inklusi. Data yang dikumpulkan meliputi karakteristik demografis, status merokok, komorbiditas, LOS, serta terapi farmakologis yang diberikan selama perawatan. Kelengkapan farmakoterapi didefinisikan secara operasional berdasarkan dokumentasi penggunaan tiga kelas obat inti yang memodifikasi penyakit dan direkomendasikan untuk tata laksana fase akut UAP, yaitu terapi antiplatelet (tunggal atau ganda), terapi statin, dan terapi beta-blocker, berdasarkan rekomendasi inti fase akut dalam pedoman ESC 2023 dan AHA/ACC 2023, yang diberikan pada waktu tertentu selama perawatan inap. Analisis deskriptif digunakan untuk merangkum karakteristik pasien dan penggunaan obat, sedangkan analisis bivariat dilakukan untuk menilai hubungan antara kelengkapan farmakoterapi dan LOS. Sebagian besar pasien berjenis kelamin laki-laki (62,5%) dan berada pada kelompok usia 40–59 tahun (47,9%) atau ≥60 tahun (43,1%), dengan median LOS selama 4 hari (rentang interkuartil 3–5). Kelas obat yang paling sering diresepkan adalah statin (92,4%), beta-blocker (91,7%), aspirin (88,2%), serta ACE inhibitor atau ARB (86,1%). Terapi antiplatelet ganda diberikan pada 66,7% pasien, sedangkan antikoagulan digunakan pada 28,5% pasien. Analisis bivariat menunjukkan tidak terdapat hubungan yang bermakna secara statistik antara kelengkapan farmakoterapi dan lama rawat inap (p = 0,642). Sebagai kesimpulan, pasien UAP yang dirawat inap umumnya menerima terapi farmakologis yang selaras dengan rekomendasi inti tata laksana fase akut berbasis pedoman. Namun, tidak ditemukannya hubungan yang bermakna antara kelengkapan farmakoterapi dan LOS menunjukkan bahwa LOS merupakan luaran yang bersifat multifaktorial dan dipengaruhi oleh faktor klinis serta organisasi pelayanan kesehatan di luar manajemen farmakologis semata. Temuan ini menegaskan pentingnya pendekatan perawatan rawat inap yang komprehensif serta telaah obat yang terstruktur, termasuk peran farmasis klinik, dalam mengoptimalkan terapi pada pasien UAP.
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