Cardiovascular disease is a major cause of heart failure and premature deaths worldwide. It contributes substantially to the increase in health care costs. 1 The previous study showed 48% of deaths in the world were caused by cardiovascular disease. A cohort study at the Harapan Kita National Heart Center and 5 hospitals in Indonesia suggested that the death rate due to heart disease in the hospital was around 6-12% and the re-hospitalization rate was 29%. 2 Hidayat et al. reported that the total cost of INA-CBG claim for in-patient services for 18 months was Rp 42.4 triliun. 3 Up to now, the therapy for stable coronary artery disease was medical treatment in accordance with the recommendation, because it was proven to improve symptoms and prognosis unless progression of worsening occurred should be sent for revascularization. Revascularization either with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) is more effective in treating angina, reducing of anti-angina drugs need, improving exercise capacity, and quality of life, compared to medical treatment strategies alone. 4 After revascularization procedures, the coronary artery disease (CAD) patients recommended to perform in hospital base followed by community based cardiac rehabilitation.

COVID-19 has become major public health problems, with new cases and deaths growing around the world. COVID-19 has been reportedly associated with hypercoagulable state which can lead to venous thromboembolism (VTE) formation. This condition is also associated with worse outcomes in COVID-19 patients, therefore, it is critical for clinicians to identify this condition and manage it accordingly. VTE formation in COVID-19 occurs through several mechanisms, such as inflammatory reaction leading to hypercoagulable state and vascular dysfunction, direct vascular injury by the virus, and immobilization of the patients. The rate of VTE formation is as high as 31% in ICU patients and 9.2% in general wards patients, and it is also associated with poorer prognosis. Thromboprophylaxis with heparin, particularly low molecular weight heparin (LMWH), has been shown to improve the prognosis in these patients. A careful individual assessment is required to determine which patients will benefit from this therapy, as there are still no sufficient prospective trials to establish guidelines for VTE thromboprophylaxis in COVID-19. The assessment includes laboratory parameters such as PT, platelet count, D-dimer, fibrinogen, and other risk factors incorporated in PADUA risk assessment model (RAM), versus the risk of bleeding incorporated in IMPROVE bleeding RAM.

Background: Cardiovascular system was the second most common organ system affected by COVID-19. Cardiac injury has been reported in many COVID-19 cases. The purpose of this study was to investigate the correlation between cardiac injury with mortality in COVID-19 patients. Methods: We performed a systematic review and meta-analysis study. The relevant studies were identified through scientific electronic databases such as PubMed, Cochrane, and ScienceDirect up to August 2020. The study quality assessment was conducted using the GRADE approach. The pooled odds ratio (OR) and 95% confidence interval (CI) were estimated using the random-effects model. Results: A total of 10 studies involving 2619 patients were included in the meta-analysis. The incidence of cardiac injury in COVID-19 patients was 28.5%. The all-cause mortality was significantly higher in patients with cardiac injury (52.8% vs. 13.1%; OR = 13.78; 95% CI = 7.22-26.32; I 2 = 88%; Z= 7.95; P < 0.00001). Conclusion: Cardiac injury is associated with higher mortality in COVID-19 patients. The cardiac injury should be considered as an important variable in the risk stratification for mortality in COVID-19.

Background:In patients with acute coronary syndrome (ACS), the role of admission blood pressure (BP) on outcomes remains inconclusive.Objective:This study aimed to investigate the association between admission BP and various outcomes in patients hospitalized for ACS.Method:In this cross-sectional study, 279 patients who admitted with ACS to Kediri District Hospital and Bogor General Hospital between January and June 2020 were included. Data were analyzed using SPSS software v25.Result:There was association between hypertension status on admission and diagnosis; there were more hypertensive patients with non-ST segment elevation (NSTE) ACS compared to ST segment elevation (STE) ACS diagnosis (p = 0.002); and significant difference on admission systolic BP between STE-ACS and NSTE-ACS patients (p < 0.00001). Patients who died during hospitalization had significantly lower admission systolic BP compared to survived patients (p = 0.001). Patients with reduced ejection fraction (EF) on follow-up echocardiography had significantly lower admission systolic BP compared to patients with normal EF (p = 0.014). Patients with diastolic dysfunction on follow-up echocardiography had significantly higher admission systolic BP compared to patients without diastolic dysfunction (p = 0.009). No significant difference on length of stay between hypertensive and non-hypertensive patients (p = 0.416).Conclusion:Lower admission systolic BP was associated with increased in-hospital mortality and reduced EF, while higher systolic BP was associated with diastolic dysfunction.

Pulmonary hypertension (PH)has been associated with hemolytic anemia. The prevalence of PH in hemolytic anemia is estimated to be as high as 10-40%, and reportsarepresenting poor prognosis in this subset of patients. PH associated with autoimmune hemolytic anemia (AIHA) is still rarely discussed,and there is paucity of literature regarding its precise pathophysiology and treatment. Here, we describe a case of PH associated with AIHA. A 34-year old woman came to our center with chief complaint of dyspnea on exertion. She was previously diagnosed with AIHA with positive direct Coomb's test. Physical examination, chest X-ray and echocardiography were consistent with pulmonary hypertension. The diagnosis of group 5 pulmonary hypertension was made. Although rare, the association between chronic hemolytic anemia and PH is evident, through several mechanisms involving nitric oxide inactivation, direct injury oftheendothelium, oxidative damage, thromboembolic formation, and left ventricular dysfunction. The management of PH in hemolytic disorders comprises treatment of underlying hemolytic disorder and PH-specific therapies. For PH specific therapy, to date, there are no therapies that have been fully studied for these specific patient population. Our patient was given bisoprolol, furosemide, amlodipine, spironolactone, candesartan, beraprost sodium and sildenafil. On follow up twomonths later, her functional status was improved. In summary, PH associated with AIHA develop via multifactorial and complex mechanisms. PH in AIHA could be detected with meticulous history taking, physical examination, chest X-ray and echocardiography, and treatment with vasodilating agents were shown to improve the PH.