RISIKO KEMATIAN AKIBAT PENYAKIT KARDIOVASKULAR PADA KASUS DEATH ON ARRIVAL DI RSUP. DR. SARDJITO TAHUN 2018-2022

Gunawan Nata Kurrahman, dr. Beta Ahlam Gizela, DFM, Sp.FM Subsp. FK (K).; dr. Martiana Suciningtyas T. A, Sp. FM.

2026 | Tesis-Spesialis | S2 Ilmu Kedokteran Forensik

Latar belakang: Penyakit kardiovaskular menjadi sebab kematian pertama di dunia dengan onset gejala yang sangat cepat. Statistik penyebab kematian merupakan hal penting untuk pelaporan kesehatan termasuk death on arrival yang harus di upayakan mengetahui sebab matinya. Data death on arrival pada setiap negara sangat beragam. Pandemi Covid-19 dikaitkan dengan peningkatan out-of-hospital cardiac arrest sehingga meningkatkan angka death on arrival.

Tujuan: Mengetahui risiko kematian akibat penyakit kardiovaskular pada kasus death on arrival di RSUP Dr Sardjito Yogyakarta tahun 2018-2022, melihat kualitas data kematian, profil demografi, serta membandingkan data sebelum dan selama pandemi Covid-19.

Metode: Penelitian ini adalah observasional dengan rancangan cross sectional. Analisis data dilakukan secara deskriptif, selanjutnya data dilakukan analisis untuk mencari odds ratio dan relative risk pada faktor risiko jenis kelamin berdasarkan kategori kelompok usia terhadap terjadinya penyakit kardiovaskular pada kasus death on arrival di RSUP Dr. Sardjito Yogyakarta tahun 2018-2022.

Hasil: Kualitas data kematian pasien death on arrival di RSUP Dr. Sardjito Yogyakarta cukup memadai. Pada data tersebut didapatkan hasil pasien death on arrival di RSUP Dr. Sardjito Yogyakarta tahun 2018-2022 sebanyak 439 dari 1.707 kasus pasien meninggal di IGD. Kasus death on arrival paling banyak terjadi pada tahun 2021 (n= 185; 42,1%), laki-laki mendominasi kasus dengan (n=256; 58,3%), kategori umur paling banyak adalah manula (n=118; 26,9%), dan underlying cause of death paling banyak adalah penyakit kardiovaskular (n=118; 26,9%). Pada masa pandemi, underlying cause of death paling banyak adalah Covid-19 (n=102; 32,38%) dan jumlah kasus death on arrival pada masa pandemi Covid-19 jauh lebih banyak dibanding sebelum pandemi Covid-19 (n=315; 71,7%). Laki-laki memiliki rasio peluang lebih tinggi daripada perempuan untuk mengalami kematian akibat penyakit kardiovaskular pada kasus death on arrival (OR=2,259), rasio peluang ini meningkat perlahan berdasarkan kategori umur dan mencapai titik tertinggi pada kategori umur lansia awal lalu menurun sampai manula. Resiko relatif juga berjalan beriringan dengan rasio peluang tersebut.

Kesimpulan: Risiko kematian akibat penyakit kardiovaskular pada kasus death on arrival di RSUP Dr Sardjito Yogyakarta tahun 2018 sampai 2022 lebih tinggi pada laki-laki dibandingkan perempuan dan risiko ini meningkat perlahan berdasarkan kategori umur dan mencapai titik tertinggi pada kategori umur lansia awal.

Background: Cardiovascular disease is the leading cause of death worldwide, often characterized by a rapid onset of symptoms. Statistics on causes of death are essential for health reporting, including death on arrival cases, for which determining the underlying cause of death should be actively pursued. Death on arrival data vary considerably across countries. The Covid-19 pandemic has been associated with an increase in out-of-hospital cardiac arrest, consequently contributing to a rise in death on arrival incidence.

Objective: This study aims to determine the mortality risk attributable to CVD in DOA cases at Dr. Sardjito General Hospital, from 2018 to 2022; to assess the quality of mortality data; to describe the demographic profile of cases; and to compare data from the pre-pandemic period with that of the Covid-19 pandemic period.

Method: This study employed an observational design with a cross-sectional approach. Data were analyzed descriptively, followed by further analysis to calculate odds ratios and relative risks for the risk factor of sex, stratified by age group categories, in relation to the occurrence of CVD among DOA cases at Dr. Sardjito General Hospital Yogyakarta, during the period 2018–2022.

Results: The quality of mortality data for death on arrival patients at Dr. Sardjito General Hospital Yogyakarta, was deemed adequate. The dataset comprised 439 deaths on arrival cases out of 1,707 fatalities recorded in the Emergency Department between 2018 and 2022. The highest annual incidence occurred in 2021 (n=185; 42.1%). Males predominated among cases (n=256; 58.3%). The largest age group was the oldest-old category (n=118; 26.9%), and cardiovascular disease constituted the leading underlying cause of death (n=118; 26.9%). During the pandemic period, Covid-19 emerged as the predominant underlying cause of death (n=102; 32.38%), and death on arrival cases were markedly more numerous during the Covid-19 pandemic than in the pre-pandemic period (n=315; 71.7%). Males demonstrated a higher odds of death attributable to cardiovascular disease in death on arrival cases compared to females (OR=2.259). This odds ratio increased gradually across successive age categories, reaching its peak in the early elderly group before declining in the oldest-old category. The relative risk exhibited a parallel trend with the odds ratio.

Conclusion: The risk of death attributable to cardiovascular disease in death on arrival cases at Dr. Sardjito General Hospital Yogyakarta, from 2018 to 2022 was higher in males than in females. This risk increased gradually across age categories and peaked in the early elderly age group.

Kata Kunci : death on arrival, penyakit kardiovaskular, underlying cause of death, pandemi Covid-19.