The Cardiology Service is 50 years old. What does this anniversary mean?
The Hospital Clínic Cardiology Service was one of the first to be established in Spain. It was founded in 1972 and has been one of the highly renowned services in our country and has achieved several very important milestones. To have reached 2022 and been able to maintain high standards of quality at all levels deserves a celebration and the recognition of all the professionals involved. Over the course of these 50 years, extraordinary professionals who have left an impressive legacy have devoted all or part of their working life to this service. The current challenge is to maintain and further increase the standards of quality in care, research and teaching, which they started in 1972.
What are these milestones you mentioned?
Undoubtedly, the creation of a pioneering coronary unit in the country and the modern care for acute myocardial infarction were the two initial major milestones. Later, in the field of arrhythmia, we developed a unique position of international leadership. At the same time, it is important to highlight the great role played by the research led by the service, which has formed part of our DNA since the beginning. In this sense, the contributions the Service has made to the cardiovascular literature have been of great importance.
The current challenge is to maintain and further increase the standards of quality in care, research and teaching, which they started in 1972.
How is the Service organized?
The service is currently made up of 41 staff cardiologists, 15 residents and cardiologists training in subspecialties. Moreover, we have all the nursing and administrative staff.
The Service has the Haemodynamics and Interventional Cardiology, Arrhythmia, Acute Cardiac Care and Cardiac Imaging sections, as well as the hospitalization unit. It also leads the Heart Failure Unit and the Atrial Fibrillation Unit, which involve other services in the Cardiovascular Institute and other institutes at the hospital. Cardiology is currently a very broad specialty and we cardiologists who work in the service have very different profiles: some do more clinical tasks, others focus on more interventional work, but we work together because, in the end, patients require a multidisciplinary approach.
What else do you do?
We treat a large number of patients, especially those with ischaemic heart disease, heart failure, valvular heart diseases or arrhythmia. Our care activity is very intense and the level of bed occupancy is close to 100%.
What do you do best?
Caring for our patients, I hope! Another of the activities we prioritize is research and innovation, at all times with our sights set on transferring the results of our studies to improving the care of our patients.
How will cardiology change in the coming years?
There is no doubt that the explosion in new diagnostic and therapeutic options we have experienced in recent years will continue. This is one of the fields of medicine in which most innovations have been made.
It is essential that we work in a team in order to provide patients with the most appropriate treatment according to their profile and needs.
The development of diagnostic imaging techniques and percutaneous approaches to treat cardiovascular diseases, which until now required surgery in all cases. The challenge is to be able to integrate this innovation with comprehensive patient management. And to do that, we need different profiles: cardiologists, of course, but also geriatricians, family doctors, internists, anaesthesiologists, surgeons, etc. It is essential that we work in a team in order to provide patients with the most appropriate treatment according to their profile and needs. In this respect, we have also been able to listen to patients and involve them in decision-making.
And how is that done?
It’s not easy, but the patient has to have enough information to be able to take part in the decisions that affect them. We have to sit down with the patient and explain to them that we have different alternatives for their specific problem, with advantages and disadvantages. We have to make them participate in the decision that we, as professionals, consider is best for them at that moment.
We are working with 'heart teams’. What exactly are they?
They are teams made up of experts from different disciplines related to the patient’s cardiovascular problem: haemodynamics, surgery, imaging, clinical cardiology, etc. Then together we make an assessment and decide on the best option. The patient has to understand this decision and participate in it with all the information we can give them.
What role does technology play in the relationship with the patient?
A fundamental role, and the future is very promising. Right now, the range of diagnostic and therapeutic alternatives we have is spectacular and, moreover, technology is constantly improving: for example, pacemakers, defibrillators are getting better and smaller all the time… we are able to monitor the heart rhythm of a patient who is hundreds of kilometres away and detect whether they have an arrhythmia without the patient even having to come to the consulting room.
Does technology also have its downsides?
Yes, sometimes. One may be the –increasingly high– cost of the procedures we carry out. This means that we, as professionals, have to act responsibly and provide efficient medicine. And, on the other hand, there is a risk that technology will make us lose sight of the figure of the clinical cardiologist and the family doctor. Technology is indicated to solve specific problems. However, we need a holistic vision of what is happening to the patient.
Technology is indicated to solve specific problems. However, we need a holistic vision of what is happening to the patient.
Preventing cardiovascular diseases is key.
Without a doubt, prevention is key to avoid cardiovascular health problems, and to ensure our health system is as sustainable as possible. In addition to our work as professionals, the media also have a very important role to play in disseminating healthy habits to society. In terms of health policies, there is also a long way to go. One example is the impact that the ban on smoking in enclosed spaces –bars, restaurants, work, etc.– had on tobacco consumption. Why not implement some kind of regulation on trans fat, for example? Or initiatives to promote physical exercise? We need to take global, national actions, to tackle major problems such as obesity and diabetes.
What do you feel when you are in front of a patient?
When I’m in front of a patient, I try to enjoy the moment very much. When I’m in the consulting room, I’m with a patient and I have to explain the alternatives, how we can help, it makes me very happy… this is why I studied medicine. It’s a moment that I hope is never lost, and I hope that we can continue with the close, personal treatment of patients.
The heart is a very 'magical’ organ, isn’t it?
The heart is a very interesting organ because it has the morphological and functional part, with different cavities that are capable of contracting and providing oxygen to the whole body. And then there is the electrical part, since it contains cells that are able to propagate the electrical impulse that causes the contraction. Moreover, the heart is an organ connected to our emotions: when you are nervous, in love… your heart beats faster. It’s fascinating.