Within the scope of the Ibero-American meeting which took place at the Faculty of Medicine of the University of Lisbon in April and focused on Cardiac Rehabilitation, we took the opportunity to talk with one of the most important international guests, Esteban Garcia Porrero. He is a Cardiologist, the founder of the European Association of Cardiovascular Prevention and Rehabilitation, head of the Cardiac Rehabilitation Unit of the León Hospital (Spain) since 1992, and also a member of the Working Group on Cardiac Rehabilitation of the European Society of Cardiology.

Used to presiding over congresses and other Latin American events on these matters, Esteban Porrero came to Portugal to talk about heart disease and how these diseases, which are increasingly part of the routines of our society, can be treated as chronic diseases.

We had a chance to talk between debates and challenged him to tell us more about this topic, which is becoming increasingly pressing for the medical community and arouses the interest of patients, despite being so recent.

What is the importance of creating an Association specifically focused on Rehabilitation?

Esteban Porrero: It was very hard for me to bring Cardiac Rehabilitation into Cardiology, it took me several years and we didn't always get much attention, but things have improved, there are more rehabilitation centres, but this is still a difficult topic.

But why is it still such a difficult topic?

Esteban Porrero: Because in rehabilitation we have to pay close attention to patients and, with each passing day, fewer and fewer doctors like to pay attention to their patients. We've gotten to the point of having patients complaining that doctors don't even look them in the eye, because they're busy entering the patient's data in the computer. In Cardiac Rehabilitation we have to talk to the patients, we have to let them talk and listen to their problems. And this strategy entails a lot of work for Cardiologists.

And takes a lot of time.

Esteban Porrero: Yes. Cardiac Rehabilitation, which has been discussed since the last century, has been growing and improving but, in my opinion, not as fast as it should. But there is another problem, which is that there are no Cardiologists trained in Cardiovascular Rehabilitation. I was the Director of a Master's Degree in Spain where we trained 300 Cardiologists and there was an increase in the number of rehabilitation centres after that. The problem is that we can't create a centre like these and not have properly trained staff. People need to get a good grasp of Cardiac Rehabilitation. The name is misleading, because it's not actually about rehabilitation, but rather a strategy for cardiovascular prevention. And it's the most effective for cardiovascular prevention. Do you know what our biggest problem is with the patients we treat? If we talk about patients who suffered a myocardial infarction, after one year, only 20% are appropriately following their treatment plans. This is a mirror of the world. In France, 70% of the patients who suffer heart attacks start smoking again and, in Spain, about 50% of those who smoked start smoking again, or simply never stop smoking. So we have to come up with a rehabilitation strategy to achieve better results in cardiovascular prevention. There are still a lot of pending issues, such as sex education. In Spain, there is no university training on this topic. And even in Colleges, it's purely information about reproduction, but that's not sex education. We need a different sex education for each age group. The information we pass on to an adolescent is not the same we explain to a mature patient with heart disease. This aspect is very important to improve the quality of life of people, especially women. It's all these aspects combined that allow us to fully rehabilitate our patients, with multidisciplinary groups, because one person can't know everything. So, we need more professionals.



We believe that patients will be very important in the future, because Medicine will have to listen to their opinions. We should be able to rely on them to make the right decisions, allowing them to decide and seek advice from experts. Ideally, you should assess how you want your treatments should be carried out and feel more motivated to bear the associated costs. And, you know, when we asked the patients with heart disease who go through a rehabilitation program which stage satisfied them the most, they all say it was rehabilitation. Because it's the part directly targeted at improving their quality of life and also the one that can increase their life expectancy. Patients want doctors to care about them and one of the things that continues to be overlooked by doctors, but is very important for patients, is the issue of sexuality.

Are traditional Cardiologists interested in dedicating themselves to these issues of Rehabilitation?

 

Esteban Porrero: Most of them are not interested because they don't value their relationships with their patients.

Why, is it the time factor again?

Esteban Porrero: It's about time, but there's a lot of other reasons. Rehabilitation entails costs for hospitals, requires specific medication and has to deal with the pharmaceutical industry. It's no coincidence that we have never had the support of the pharmaceutical industry. But, on the other hand, doctors live on their salaries and rehabilitation is not very profitable. Now, the fact is that you have to dedicate a lot of time to the patients, and sometimes doctors are not very sensitive to human relationships.

Joana Sousa

Editorial Team